Department of Urology, Loma Linda University Health, Loma Linda, CA; Department of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA; Department of Urology, Riverside University Health System, Moreno Valley, CA.
Department of Urology, Loma Linda University Health, Loma Linda, CA.
Urol Oncol. 2024 Nov;42(11):375.e15-375.e21. doi: 10.1016/j.urolonc.2024.06.019. Epub 2024 Aug 3.
Opioid dependence represents a public health crisis and can be observed after outpatient urologic procedures. The purpose of this study was to evaluate the risk of persistent opioid usage after radical orchiectomy for testicular cancer.
The TriNetX Research network database was queried for men between 15 and 45 years undergoing radical orchiectomy for a diagnosis of testicular cancer. All patients with N+ or M+ disease, prior opioid use, and patients who underwent chemotherapy, radiotherapy, or retroperitoneal lymph node dissection were excluded. Patients were stratified whether they were prescribed opioids or not at time of orchiectomy. The incidence of new, persistent opioid use, defined as a prescription for opioids between 3 and 15 months after orchiectomy, was evaluated.
A total of 2,911 men underwent radical orchiectomy for testicular cancer, of which 89.8% were prescribed opioids at time of orchiectomy. After propensity score matching for age, race, and history of psychiatric diagnosis, 592 patients were included (296 received opioids, 296 did not). Overall, 0% of patients who did not receive postoperative opioids developed new persistent opioid use, whereas 10.5% of patients who received postoperative opioids developed new persistent opioid use. Patients prescribed postoperative opioids for orchiectomy had statistically higher risk difference of developing new persistent opioid use (Risk Difference: 10.5%; 95% CI: 7.0-14.0; Z: 5.7; P < 0.01).
Postoperative opioid prescription following radical orchiectomy is significantly associated with developing new persistent opioid use, with 1 in 10 young men who received postoperative opioids obtaining a new prescription for opioids well beyond the postoperative period. Future efforts should emphasize nonopioid pathways for pain control following this generally minor procedure.
阿片类药物依赖是一种公共卫生危机，在门诊泌尿科手术后即可观察到。本研究的目的是评估睾丸癌根治性睾丸切除术后持续使用阿片类药物的风险。
在 TriNetX 研究网络数据库中，检索了 15 至 45 岁因睾丸癌接受根治性睾丸切除术的男性。排除了 N+或 M+疾病、既往阿片类药物使用史以及接受化疗、放疗或腹膜后淋巴结清扫术的患者。根据患者在睾丸切除术时是否开具阿片类药物将其分层。评估了新的、持续的阿片类药物使用（定义为睾丸切除术后 3 至 15 个月开具阿片类药物处方）的发生率。
共有 2911 名男性因睾丸癌接受根治性睾丸切除术，其中 89.8%的患者在睾丸切除术时开具了阿片类药物。在年龄、种族和精神疾病诊断史方面进行倾向评分匹配后，纳入了 592 名患者（296 名患者接受了阿片类药物治疗，296 名患者未接受阿片类药物治疗）。总体而言，未接受术后阿片类药物治疗的患者中，有 0%的患者出现新的持续阿片类药物使用，而接受术后阿片类药物治疗的患者中有 10.5%的患者出现新的持续阿片类药物使用。接受术后阿片类药物治疗的患者出现新的持续阿片类药物使用的风险差异有统计学意义（风险差异：10.5%；95%CI：7.0-14.0；Z：5.7；P < 0.01）。
根治性睾丸切除术后开具阿片类药物与新的持续阿片类药物使用显著相关，接受术后阿片类药物治疗的年轻男性中有 10 分之一获得了新的阿片类药物处方，远远超出了术后时期。未来应强调在这种通常轻微的手术后采用非阿片类药物控制疼痛的方法。
