Ervin-Sikhondze Brittany A, Gunaseelan Vidhya, Chua Kao-Ping, Bicket Mark C, Waljee Jennifer F, Englesbe Michael J, Brummett Chad M
Department of Anesthesiology, Michigan Medicine, Ann Arbor, Michigan, USA.
Overdose Prevention Engagement Network, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA.
Reg Anesth Pain Med. 2024 Dec 20. doi: 10.1136/rapm-2024-106068.
Previous studies suggest that new persistent opioid use (NPOU) after surgery was associated with larger perioperative opioid prescriptions, but the association between NPOU and postoperative opioid consumption is unknown.
This retrospective study included opioid naïve individuals aged 18-64 who underwent surgical procedures across 70 Michigan hospitals between July 1, 2018 and November 15, 2021 and were prescribed opioids at discharge. We used clinical and patient-reported opioid consumption data from the Michigan Surgical Quality Collaborative, a statewide surgical registry, linked with the state Prescription Drug Monitoring Program. Multivariable logistic regression modeling was used to assess the association between patient-reported opioid consumption during the 30 days after discharge and NPOU, defined as having an opioid fill during both 31-120 days and 121-210 days after discharge.
Among 36,271 patients included, 482 (1.3%) developed NPOU. These patients consumed more opioid pills in the first 30 days postoperatively than those without NPOU (mean (SD): 7.3 (8.4) 5 mg oxycodone equivalent pills vs 4.1 (5.5), SMD=-0.41). In adjusted analyses, each additional opioid pill consumed in the 30-day postoperative period was associated with a 0.05 percentage-point increase in the predicted probability of NPOU (95% CI 0.04 to 0.07 percentage points). Thus, holding all other variables constant, a 10-pill increase in consumption would be associated with a 0.5 percentage-point increase in the probability of NPOU, or a 38.4% increase relative to the baseline rate of 1.3%.
Demonstrating that opioid consumption in the first 30 days after surgery was independently associated with NPOU underscores the importance of perioperative opioid prescribing on long-term outcomes.
先前的研究表明，手术后新的持续性阿片类药物使用（NPOU）与围手术期更大的阿片类药物处方量相关，但NPOU与术后阿片类药物消费量之间的关联尚不清楚。
这项回顾性研究纳入了18至64岁未使用过阿片类药物的个体，他们于2018年7月1日至2021年11月15日期间在密歇根州的70家医院接受了外科手术，并在出院时开具了阿片类药物处方。我们使用了来自密歇根州外科质量协作组织（一个全州范围的外科手术登记处）的临床和患者报告的阿片类药物消费数据，并将其与该州的处方药监测计划相链接。多变量逻辑回归模型用于评估出院后30天内患者报告的阿片类药物消费量与NPOU之间的关联，NPOU定义为在出院后31至120天和121至210天期间均有阿片类药物配药。
在纳入的36271名患者中，482名（1.3%）出现了NPOU。这些患者术后前30天内服用的阿片类药物丸剂比未出现NPOU的患者更多（均值（标准差）：7.3（8.4）5毫克羟考酮等效丸剂对4.1（5.5），标准化均值差=-0.41）。在调整分析中，术后30天内每多服用一剂阿片类药物丸剂，NPOU的预测概率就会增加0.05个百分点（95%置信区间为0.04至0.07个百分点）。因此，在所有其他变量保持不变的情况下，消费量增加10丸将使NPOU的概率增加0.5个百分点，相对于1.3%的基线率增加38.4%。
表明术后前30天内的阿片类药物消费与NPOU独立相关，突出了围手术期阿片类药物处方对长期结局的重要性。
