开放手术与微创手术：新的持续性阿片类药物使用风险

Open versus minimally invasive surgery: risk of new persistent opioid use.

作者信息

Rashid Zayed, Woldesenbet Selamawit, Munir Muhammad Musaab, Khalil Mujtaba, Thammachack Razeen, Khan Muhammad Muntazir Mehdi, Altaf Abdullah, Pawlik Timothy M

机构信息

Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, United States.

出版信息

J Gastrointest Surg. 2025 Jan;29(1):101873. doi: 10.1016/j.gassur.2024.10.028. Epub 2024 Oct 29.

DOI:10.1016/j.gassur.2024.10.028

PMID:39481527

Abstract

BACKGROUND

New persistent opioid use (NPOU) after surgery may represent a public health issue that adversely affects health outcomes and long-term patient survival. This study aimed to characterize the risk of NPOU relative to surgical approach among different operative procedures.

METHODS

Patients who underwent either open (open surgery [OS]) or minimally invasive (minimally invasive surgery [MIS]) pneumonectomy, pancreatectomy, and colectomy between 2013 and 2020 were identified from the IBM MarketScan database. NPOU was defined as 2 subsequent opioid refills within the first 90-day period, as well as in the following 91- to 180-day period after surgery among opioid-naive patients. Multivariate logistic regression was used to characterize the association between the surgical approach and the risk of NPOU.

RESULTS

Among 45,757 patients who underwent surgery (pneumonectomy: 7.6%; pancreatectomy: 7.1%; colectomy: 85.3%), median age was 54 years (IQR, 48-60). Most individuals were female (51.5%) and had a malignant indication (67.3%) for surgery. Overall, 50.7% of patients underwent OS, whereas 49.3% of patients underwent MIS. Subsequently, 4.8% of patients developed NPOU. The likelihood of NPOU was higher among patients who underwent OS than among individuals who underwent MIS (5.9% vs 3.6%, respectively; P < .001). Patients who underwent OS had higher 6-month total milligram equivalent doses (OS: 250 [IQR, 135-600] vs MIS: 200 [IQR, 100-421]) and days of opioid use (OS: 7 [IQR, 3-15] vs MIS: 5 [IQR, 3-10]) (both P < .001). Relative to OS, MIS was associated with 35% lower odds of NPOU (0.65; 95% CI, 0.59-0.71).

CONCLUSION

1 in 20 patients who underwent surgery experienced NPOU. MIS was associated with fewer days of opioid use and lower dosages, which translated into lower NPOU after surgery.

摘要

背景

手术后新出现的持续性阿片类药物使用（NPOU）可能是一个公共卫生问题，会对健康结果和患者长期生存产生不利影响。本研究旨在确定不同手术操作中，相对于手术方式而言的NPOU风险特征。

方法

从IBM MarketScan数据库中识别出2013年至2020年间接受开放性手术（OS）或微创手术（MIS）进行肺切除术、胰腺切除术和结肠切除术的患者。NPOU被定义为在最初90天内以及术后91至180天内，阿片类药物初治患者后续有两次阿片类药物续方。采用多因素逻辑回归分析来确定手术方式与NPOU风险之间的关联。

结果

在45757例接受手术的患者中（肺切除术：7.6%；胰腺切除术：7.1%；结肠切除术：85.3%），中位年龄为54岁（四分位间距，48 - 60岁）。大多数患者为女性（51.5%），且手术指征为恶性（67.3%）。总体而言，50.7%的患者接受了OS，而49.3%的患者接受了MIS。随后，4.8%的患者出现了NPOU。接受OS的患者发生NPOU的可能性高于接受MIS的患者（分别为5.9%和3.6%；P <.001）。接受OS的患者6个月的总毫克当量剂量更高（OS：250 [四分位间距，135 - 600] vs MIS：200 [四分位间距，100 - 421]），阿片类药物使用天数也更多（OS：7 [四分位间距，3 - 15] vs MIS：5 [四分位间距，3 - 10]）（两者P <.001）。相对于OS，MIS与NPOU的发生几率降低35%相关（0.65；95%置信区间，0.59 - 0.71）。