Luby Alexandra O, Alessio-Bilowus Dominic, Hu Hsou Mei, Brummett Chad M, Waljee Jennifer F, Bicket Mark C
Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI.
Department of Surgery, Michigan Medicine, Ann Arbor, MI.
Ann Surg. 2025 Mar 1;281(3):347-352. doi: 10.1097/SLA.0000000000006461. Epub 2024 Aug 1.
To define recent trends in opioid prescribing after surgery and new persistent opioid use in the United States.
New persistent opioid use after surgery among opioid-naive individuals has emerged as an important postoperative complication. In response, initiatives to promote more appropriate postoperative opioid prescribing have been adopted in recent years. However, current estimates of opioid prescribing and new persistent opioid use following surgery remain unknown.
A retrospective cohort study of opioid-naive privately insured adult patients undergoing 17 common surgical procedures between 2013 and 2021 was conducted utilizing multi-payer claims data from the Health Care Cost Institute (HCCI). Initial opioid prescription size in oral morphine equivalents (OMEs) and new persistent opioid use were the outcomes of interest. Trends in opioid prescribing and rates of new persistent opioid use were evaluated across the study period. Mixed effects logistic regression was performed to evaluate independent predictors of new persistent opioid use while adjusting for patient-level factors and year.
Among 989,354 opioid-naive individuals, the adjusted initial opioid prescription size decreased from 282 mg OME to 164 mg OME, a reduction of 118 mg OME (95% CI: 116-120). The adjusted incidence of new persistent opioid use decreased from 2.7% in 2013 (95% CI: 2.6%-2.8%) to 1.1% in 2021 (95% CI: 1.0%-1.2%). For every 30 OME increase in initial opioid prescription size, new persistent opioid use increased by 3.1%. Other predictors of new persistent opioid use included preoperative nonopioid controlled substances fills [31-365 days: adjusted odds ratio (aOR)=1.78, 95% CI: 1.70-1.86; 0-30 days: aOR=2.71, 95% CI: 2.59-2.84] and undergoing orthopedic procedures [total knee arthroplasty (aOR=3.43, 95% CI: 3.15-3.72); shoulder arthroscopy (aOR=2.39, 95% CI: 2.24-2.56)].
Both opioid prescription size after surgery and new persistent opioid use decreased over the last decade, suggesting that opioid stewardship practices had favorable effects on the risk of long-term opioid use.
明确美国术后阿片类药物处方及新的持续性阿片类药物使用的近期趋势。
在未使用过阿片类药物的个体中，术后出现新的持续性阿片类药物使用已成为一种重要的术后并发症。作为应对措施，近年来已采取举措促进更合理的术后阿片类药物处方。然而，目前对于术后阿片类药物处方及新的持续性阿片类药物使用的估计仍不明确。
利用医疗保健成本研究所（HCCI）的多支付方索赔数据，对2013年至2021年间接受17种常见外科手术的未使用过阿片类药物的私人保险成年患者进行了一项回顾性队列研究。以口服吗啡当量（OME）表示的初始阿片类药物处方量及新的持续性阿片类药物使用情况为感兴趣的结果。评估了整个研究期间阿片类药物处方的趋势及新的持续性阿片类药物使用发生率。进行了混合效应逻辑回归分析，以评估新的持续性阿片类药物使用的独立预测因素，同时对患者层面因素和年份进行了调整。
在989,354名未使用过阿片类药物的个体中，调整后的初始阿片类药物处方量从282毫克OME降至164毫克OME，减少了118毫克OME（95%置信区间：116 - 120）。新的持续性阿片类药物使用的调整后发生率从2013年的2.7%（95%置信区间：2.6% - 2.8%）降至2021年的1.1%（95%置信区间：1.0% - 1.2%）。初始阿片类药物处方量每增加30 OME，新的持续性阿片类药物使用增加3.1%。新的持续性阿片类药物使用的其他预测因素包括术前非阿片类管制物质填充[31 - 365天：调整后的优势比（aOR）=1.78，95%置信区间：1.70 - 1.86；0 - 30天：aOR = 2.71，95%置信区间：2.59 - 2.84]以及接受骨科手术[全膝关节置换术（aOR = 3.43，95%置信区间：3.15 - 3.72）；肩关节镜检查（aOR = 2.39，95%置信区间：2.24 - 2.56）]。
在过去十年中，术后阿片类药物处方量及新的持续性阿片类药物使用均有所下降，这表明阿片类药物管理措施对长期使用阿片类药物的风险产生了有利影响。
