Kertai Miklos D, Rayl Rachel, Larach Daniel B, Shah Ashish S, Bruehl Stephen
Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN.
Kentucky College of Osteopathic Medicine, Pikeville, KY.
J Cardiothorac Vasc Anesth. 2025 Feb;39(2):461-469. doi: 10.1053/j.jvca.2024.11.037. Epub 2024 Nov 29.
This study was designed to test whether a negative affect phenotype reflecting depression, anxiety, anger, and pain catastrophizing predicts inpatient and outpatient opioid use outcomes following cardiac surgery.
In a single-center prospective observational pilot study, the authors obtained validated measures of negative affect and opioid-related phenotype preoperatively and collected opioid use and opioid misuse-related outcomes at 30-day postoperative follow-up.
Quaternary medical center.
The final dataset included 30 adult patients undergoing elective cardiac surgery procedures between August 19, 2022, and August 29, 2023.
None.
Opioid outcomes included: (1) total inpatient postoperative opioid use (in milligram morphine equivalents), (2) self-reported number of days that prescribed outpatient opioids were used during the 30-day follow-up period (Timeline Followback method), and (3) number of opioid misuse-related behaviors (Current Opioid Misuse Measure-9) at 30-day follow-up. Generalized linear model analyses using a Poisson distribution indicated that greater preoperative depression, anxiety, anger, pain catastrophizing, and opioid misuse risk (indexed by the Screener and Opioid Assessment for Patients with Pain- Revised) were all significantly (p < 0.002) associated with greater inpatient and outpatient postoperative opioid use, as well as more opioid misuse-related behaviors at 30-day follow-up (p < 0.001).
Patients with higher preoperative levels of negative affect (depression, anxiety, anger, and pain catastrophizing) use more inpatient and outpatient opioid analgesics following cardiac surgery, a pattern similar to noncardiac surgery populations. Results support further study of patient-specific approaches to opioid prescribing to reduce the risk for opioid use disorder post-cardiac surgery.
本研究旨在测试反映抑郁、焦虑、愤怒和疼痛灾难化的消极情绪表型是否能预测心脏手术后住院患者和门诊患者的阿片类药物使用结果。
在一项单中心前瞻性观察性试点研究中，作者在术前获得了经过验证的消极情绪和阿片类药物相关表型测量值，并在术后30天随访时收集了阿片类药物使用情况和与阿片类药物滥用相关的结果。
四级医疗中心。
最终数据集包括2022年8月19日至2023年8月29日期间接受择期心脏手术的30名成年患者。
无。
阿片类药物结果包括：（1）术后住院期间阿片类药物的总使用量（以毫克吗啡当量计），（2）自我报告的在30天随访期内使用门诊处方阿片类药物的天数（时间线追溯法），以及（3）30天随访时与阿片类药物滥用相关行为的数量（当前阿片类药物滥用测量量表-9）。使用泊松分布的广义线性模型分析表明，术前更高的抑郁、焦虑、愤怒、疼痛灾难化程度以及阿片类药物滥用风险（以疼痛患者筛查和阿片类药物评估修订版为指标）均与术后住院患者和门诊患者更多地使用阿片类药物以及30天随访时更多的阿片类药物滥用相关行为显著相关（p<0.002）（p<0.001）。
术前消极情绪（抑郁、焦虑、愤怒和疼痛灾难化）水平较高的患者在心脏手术后使用更多的住院和门诊阿片类镇痛药物，这一模式与非心脏手术人群相似。研究结果支持进一步研究针对患者个体的阿片类药物处方方法，以降低心脏手术后阿片类药物使用障碍的风险。
