Busigó Torres Rodnell, Alasadi Husni, Duey Akiro H, Song Junho, Poeran Jashvant, Stern Brocha Z, Chaudhary Saad B
Leni and Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Global Spine J. 2025 May;15(4):2425-2434. doi: 10.1177/21925682241301684. Epub 2024 Nov 14.
Study DesignRetrospective cohort study.ObjectiveTo assess the association between undergoing spine surgery in an ambulatory surgical center (ASC) vs a hospital outpatient department (HOPD) and (a) perioperative opioid prescription patterns and (b) prolonged opioid use.MethodsData from the Merative MarketScan Database included patients aged 18-64 who underwent single-level or multilevel anterior cervical discectomy and fusion (ACDF) or lumbar decompression between January 2017 and June 2021. Primary outcomes included receipt of a perioperative opioid prescription, perioperative oral morphine milligram equivalents (MMEs), and prolonged opioid use (defined as opioid prescription 91-180 days post-surgery). Secondary outcomes included the number of perioperative opioid prescriptions filled (single/multiple) and type of initial perioperative opioid filled (potent/weak). Analysis of prolonged opioid use was limited to opioid-naive patients. Propensity score matching (1 ASC to 3 HOPD cases) and logistic regression models were used for analysis.ResultsThe study included 11,654 ACDF and 26,486 lumbar decompression patients. For ACDF, ASCs had higher odds of an initial potent opioid prescription (OR = 1.18, 95% CI 1.08-1.30, < .001) and higher total adjusted mean MMEs (+21.14, 95% CI 3.08-39.20, = .02). For lumbar decompression, ASCs had increased odds of an initial potent opioid (OR = 1.23, 95% CI 1.16-1.30, < .001) but lower odds of multiple opioid prescriptions (OR = 0.90, 95% CI 0.85-0.96, < .001). There was no significant association between the surgery setting and prolonged opioid use.ConclusionDifferences in perioperative opioid prescribing were observed between ASCs and HOPDs, but there was no increase in prolonged opioid use in ASCs. Further research is needed to optimize postoperative pain management in different outpatient settings.
研究设计
回顾性队列研究。
目的
评估在门诊手术中心（ASC）与医院门诊部（HOPD）接受脊柱手术与（a）围手术期阿片类药物处方模式以及（b）长期使用阿片类药物之间的关联。
方法
来自默克多市场扫描数据库的数据包括2017年1月至2021年6月期间接受单节段或多节段前路颈椎间盘切除融合术（ACDF）或腰椎减压术的18 - 64岁患者。主要结局包括围手术期阿片类药物处方的开具情况、围手术期口服吗啡毫克当量（MMEs）以及长期使用阿片类药物（定义为术后91 - 180天的阿片类药物处方）。次要结局包括开具的围手术期阿片类药物处方数量（单张/多张）以及首次开具的围手术期阿片类药物类型（强效/弱效）。对长期使用阿片类药物的分析仅限于未使用过阿片类药物的患者。采用倾向得分匹配法（1例ASC匹配3例HOPD病例）和逻辑回归模型进行分析。
结果
该研究纳入了11,654例ACDF患者和26,486例腰椎减压患者。对于ACDF手术，ASC开具初始强效阿片类药物处方的几率更高（OR = 1.18，95%CI 1.08 - 1.30，P <.001），调整后的总平均MMEs也更高（+21.14，95%CI 3.08 - 39.20，P =.02）。对于腰椎减压手术，ASC开具初始强效阿片类药物的几率增加（OR = 1.23，95%CI 1.16 - 1.30，P <.001），但开具多张阿片类药物处方的几率较低（OR = 0.90，95%CI 0.85 - 0.96，P <.001）。手术地点与长期使用阿片类药物之间无显著关联。
结论
ASC和HOPD在围手术期阿片类药物处方方面存在差异，但ASC中并未出现长期使用阿片类药物增加的情况。需要进一步研究以优化不同门诊环境下的术后疼痛管理。
