Abstract：
BACKGROUND: Although excessive opioid use is a significant global health issue, there is a lack of literature on the prescribing patterns for postoperative opioid use and exposure after discharge among surgical patients. This study aimed to examine the rate and predictors of opioid dispensing and high opioid exposure after hospital discharge from surgery in New Zealand (NZ) between January 2007 to December 2019.
METHODS: This is a retrospective population-based cohort study inclusive of all ages and surgical specialties. Data were obtained from the NZ Ministry of Health\'s national health databases.
RESULTS: 1 781 059 patients were included in the study and 20.9% (n = 371 882) of surgical patients received opioids within 7 days after hospital discharge. From those who were dispensed with opioids after hospital discharge, 36.6% (n = 134 646) had high opioid exposure. Orthopaedic surgery (AOR 6.97; 95% CI 6.82-7.13) and history of opioid use (AOR 3.18; 95% CI 2.86-3.53) increased the odds of postoperative opioid dispensing and high opioid exposure respectively. Severe multi-morbidity burden (AOR 0.76; 95% CI 0.73-0.78) and alcohol misuse (AOR 0.84; 95% CI 0.77-0.93) lowered the odds of postoperative opioid dispensing and high opioid exposure respectively.
CONCLUSIONS: Our findings suggest a concerning rate of high opioid exposure among surgical patients after discharge. The predictors for postoperative opioid dispensing and high opioid exposure identified in our study provide insight into opioid prescribing patterns in NZ and inform future postoperative pain management.
METHODS: This is a retrospective population-based cohort study inclusive of all ages and surgical specialties. Data were obtained from the NZ Ministry of Health\'s national health databases.
RESULTS: 1 781 059 patients were included in the study and 20.9% (n = 371 882) of surgical patients received opioids within 7 days after hospital discharge. From those who were dispensed with opioids after hospital discharge, 36.6% (n = 134 646) had high opioid exposure. Orthopaedic surgery (AOR 6.97; 95% CI 6.82-7.13) and history of opioid use (AOR 3.18; 95% CI 2.86-3.53) increased the odds of postoperative opioid dispensing and high opioid exposure respectively. Severe multi-morbidity burden (AOR 0.76; 95% CI 0.73-0.78) and alcohol misuse (AOR 0.84; 95% CI 0.77-0.93) lowered the odds of postoperative opioid dispensing and high opioid exposure respectively.
CONCLUSIONS: Our findings suggest a concerning rate of high opioid exposure among surgical patients after discharge. The predictors for postoperative opioid dispensing and high opioid exposure identified in our study provide insight into opioid prescribing patterns in NZ and inform future postoperative pain management.
摘要：
背景：尽管过量使用阿片类药物是一个重大的全球健康问题，缺乏关于手术患者术后阿片类药物使用和出院后暴露的处方模式的文献.这项研究旨在检查2007年1月至2019年12月期间新西兰（NZ）手术出院后阿片类药物分配和高阿片类药物暴露的发生率和预测因素。
方法：这是一项基于人群的回顾性队列研究，包括所有年龄和外科专业。数据来自新西兰卫生部的国家卫生数据库。
结果：1781059例患者被纳入研究，20.9%(n=371882)的手术患者在出院后7天内接受阿片类药物治疗。出院后被分配阿片类药物的人，36.6%(n=134646)的阿片类药物暴露较高。骨科手术（AOR6.97;95％CI6.82-7.13）和阿片类药物使用史（AOR3.18;95％CI2.86-3.53）分别增加了术后阿片类药物分配和高阿片类药物暴露的几率。严重的多发病负担（AOR0.76;95％CI0.73-0.78）和酒精滥用（AOR0.84;95％CI0.77-0.93）分别降低了术后阿片类药物分配和高阿片类药物暴露的几率。
结论：我们的研究结果表明，手术患者出院后阿片类药物高暴露率令人担忧。在我们的研究中确定的术后阿片类药物分配和高阿片类药物暴露的预测因素提供了对新西兰阿片类药物处方模式的见解，并为未来的术后疼痛管理提供了信息。
方法：这是一项基于人群的回顾性队列研究，包括所有年龄和外科专业。数据来自新西兰卫生部的国家卫生数据库。
结果：1781059例患者被纳入研究，20.9%(n=371882)的手术患者在出院后7天内接受阿片类药物治疗。出院后被分配阿片类药物的人，36.6%(n=134646)的阿片类药物暴露较高。骨科手术（AOR6.97;95％CI6.82-7.13）和阿片类药物使用史（AOR3.18;95％CI2.86-3.53）分别增加了术后阿片类药物分配和高阿片类药物暴露的几率。严重的多发病负担（AOR0.76;95％CI0.73-0.78）和酒精滥用（AOR0.84;95％CI0.77-0.93）分别降低了术后阿片类药物分配和高阿片类药物暴露的几率。
结论：我们的研究结果表明，手术患者出院后阿片类药物高暴露率令人担忧。在我们的研究中确定的术后阿片类药物分配和高阿片类药物暴露的预测因素提供了对新西兰阿片类药物处方模式的见解，并为未来的术后疼痛管理提供了信息。
