手术后持续使用阿片类药物的发生率及危险因素——一项回顾性二次数据分析
The Incidence and Risk Factors of Persis tent Opioid Use After Surgery—A Retrospective Secondary Data Analysis.
作者信息
Dreiling Johannes, Rose Norman, Arnold Christin, Baumbach Philipp, Fleischmann-Struzek Carolin, Kubulus Christine, Komann Marcus, Marschall Ursula, Rittner Heike Lydia, Volk Thomas, Meißner Winfried, Schwarzkopf Daniel
机构信息
Department of Anesthesiology and Intensive Care Medicine, Friedrich Schiller University Jena, University Hospital, Friedrich Schiller University Jena; Institute of Infectious Diseases and Infection Control, Jena University Hospital Friedrich Schiller University Jena; Department of Anesthesiology, Intensive Care Medicine, and Pain Therapy, Saarland University Hospital and Faculty of Medicine, Saarland University, Homburg; BARMER Institute for Health Care System Research (bifg), Berlin; Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine, and Pain Therapy, University Hospital Würzburg, Center for Interdisciplinary Pain Therapy, Würzburg.
出版信息
Dtsch Arztebl Int. 2024 Nov 15;121(23):757-763. doi: 10.3238/arztebl.m2024.0200.
BACKGROUND
The risk of persistent postoperative opioid use (PPOU) and its association with the type of surgery are still unclear in Germany.
METHODS
We conducted a nationwide retrospective cohort study on the basis of claims data from BARMER, a statutory health insurance carrier in Germany. Opioid-naive adults who did not have cancer and who underwent inpatient surgery in 2018 were included in the study. The operations were divided into 103 categories. PPOU was defined as the prescribing of opioids between post - operative days 1 and 90 and also between postoperative days 91 and 180 after hospital discharge. Patient-associated risk factors in the 12 months before surgery were investigated.
RESULTS
203 327 patients were included. 1.4% had PPOU (95% confidence interval [1.4; 1.5]). There were major differences between operation groups: major amputations and orthopedic procedures carried the greatest risk for the development of PPOU. The type of surgery had a larger effect on the risk of PPOU than preexisting risk factors (explained variance 22.3% vs. 14.3%). Among such factors, alcohol abuse and preexisting treatment with antidepressant drugs were associated with the highest risk for PPOU (odds ratios [OR] 1.515 [1.277; 1.797] and 2.131 [1.943; 2.336]).
CONCLUSION
The incidence of PPOU in Germany is low (1.4%). The type of surgery plays an important role in its development.
背景
在德国，术后持续使用阿片类药物（PPOU）的风险及其与手术类型的关联仍不明确。
方法
我们基于德国法定健康保险公司BARMER的理赔数据进行了一项全国性回顾性队列研究。研究纳入了2018年接受住院手术、未患癌症且未使用过阿片类药物的成年人。手术分为103类。PPOU定义为术后第1天至90天以及出院后术后第91天至180天开具阿片类药物的情况。对手术前12个月内与患者相关的风险因素进行了调查。
结果
共纳入203327例患者。1.4%的患者出现PPOU（95%置信区间[1.4；1.5]）。各手术组之间存在显著差异：大截肢手术和骨科手术发生PPOU的风险最高。手术类型对PPOU风险的影响大于既往风险因素（解释方差分别为22.3%和14.3%）。在这些因素中，酗酒和既往使用抗抑郁药物治疗与PPOU的最高风险相关（比值比[OR]分别为1.515[1.277；1.797]和2.131[1.943；2.336]）。
结论
德国PPOU的发生率较低（1.4%）。手术类型在其发生过程中起重要作用。
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