美国术后长期使用处方阿片类药物情况（2017 - 2022年）：一项基于人群的研究
Long-term prescription opioid use following surgery in the US (2017-2022): a population-based study.
作者信息
Schoenfeld Andrew J, Cooper Zara, Banaag Amanda, Gong Jonathan, Bryan Matthew R, Coles Christian, Koehlmoos Tracey P
机构信息
Center for Surgery and Public Health, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
出版信息
Lancet Reg Health Am. 2024 Dec 4;40:100948. doi: 10.1016/j.lana.2024.100948. eCollection 2024 Dec.
BACKGROUND
Over the last decade, numerous efforts have been made to combat the opioid crisis globally. The impact of these strategies has not been adequately measured and may differ across populations depending on baseline risk. We compared changes in long-term prescription opioid use following surgery within a national US cohort, between 2017 and 2022.
METHODS
We used TRICARE claims data to identify individuals undergoing one of 14 representative surgical procedures. The rate of post-operative long-term prescription opioid use during 2020-22 was compared to 2017-19. We used modified Poisson regression analyses to adjust for confounding. We performed secondary analyses that accounted for interactions between the time period and race, pre-operative opioid use, surgical care setting and our proxy for socioeconomic status.
FINDINGS
Our data derived from TRICARE claims. We included 410,326 surgical events. Across both time periods, there were 213,212 females (52%), with a median age of 53 (IQR 22) and 207,188 individuals of White race (50%). The median co-morbidity index was 0 (IQR = 0). The rate of long-term post-operative opioid use was 11% in 2017-19, which reduced to 6% in 2020-22 (risk ratio [RR] 0.51; 95% CI 0.50, 0.52). Reductions were appreciated across all census divisions in the US and across all racial minorities, those of lower socioeconomic background and pre-operative chronic opioid users. Following multivariable analysis, there was a significant reduction in long-term prescription opioid use (RR 0.61; 95% CI 0.60, 0.63) after surgery in 2020-22 as compared to 2017-19.
INTERPRETATION
This investigation represents one of the largest and most comprehensive longitudinal assessments of opioid use following surgery. We found clinically relevant reductions in post-operative prescription opioid use in 2020-22 as compared to 2017-19. Given the representative nature of the study cohort, we believe these results are reflective of national trends.
FUNDING
U.S. Department of Defense, Defense Health Agency (award # HU00012120089).
背景
在过去十年中，全球为应对阿片类药物危机做出了诸多努力。这些策略的影响尚未得到充分衡量，并且可能因人群的基线风险不同而有所差异。我们比较了2017年至2022年美国一个全国队列中手术后长期使用处方阿片类药物的变化情况。
方法
我们使用了军事医疗保健系统（TRICARE）的理赔数据来识别接受14种代表性外科手术之一的个体。将2020 - 2022年术后长期使用处方阿片类药物的比率与2017 - 2019年进行比较。我们使用修正泊松回归分析来调整混杂因素。我们进行了二次分析，考虑了时间段与种族、术前阿片类药物使用情况、手术护理环境以及我们用于代表社会经济地位的指标之间的相互作用。
结果
我们的数据源自TRICARE理赔记录。我们纳入了410,326例外科手术事件。在两个时间段内，有213,212名女性（52%），中位年龄为53岁（四分位间距为22），以及207,188名白人（50%）。合并症指数中位数为0（四分位间距 = 0）。2017 - 2019年术后长期使用阿片类药物的比率为11%，在2020 - 2022年降至6%（风险比[RR] 0.51；95%置信区间0.50, 0.52）。美国所有普查区以及所有少数族裔、社会经济背景较低者和术前长期使用阿片类药物者的使用比率均有所下降。经过多变量分析，与2017 - 2019年相比，2020 - 2022年手术后长期使用处方阿片类药物的情况有显著减少（RR 0.61；95%置信区间0.60, 0.63）。
解读
这项调查是对手术后阿片类药物使用情况规模最大、最全面的纵向评估之一。我们发现，与2017 - 2019年相比，2020 - 2022年术后处方阿片类药物的使用在临床上有显著减少。鉴于研究队列的代表性，我们认为这些结果反映了全国趋势。
资助
美国国防部国防卫生局（资助编号# HU00012120089）。
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