评估阻塞性睡眠呼吸暂停手术后长期使用阿片类药物的发生率和危险因素。
使用IBMMarketScan研究数据库,我们确定了在2007年至2015年间接受过多种睡眠手术的成年人(>18岁).包括在手术前后有1年保险的个人。在感兴趣的程序之后的一年中的其他麻醉事件和在手术前一年内填写阿片类药物处方的那些人(不是幼稚的)被排除。结果包括持续使用阿片类药物的比率(术后90-180天补充阿片类药物处方),长期使用(术后181-365天补充阿片类药物处方),和不适当的使用(>100毫克吗啡当量)。评估的变量包括人口统计,外科手术,和合并症。
共有10,766例外科手术符合纳入标准。围手术期阿片类药物处方率有增加的趋势。经过多变量逻辑回归分析,围手术期阿片类药物处方和吸烟是阿片类药物不当使用的独立危险因素(比值比[OR]=31.51,P<.001;OR=1.41,P=.016).阿片类药物处方和高血压是阿片类药物持续使用的独立危险因素(OR=37.8,P<.001,OR=1.38,P=.008)。围手术期阿片类药物处方,以前的阿片类药物依赖诊断,吸烟,男性和男性与持续长期使用阿片类药物相关(OR分别为73.1,8.13,1.95和1.55;P<.001,P=.020,P=.024和P=.032)。
虽然不同社会正在努力控制阿片类药物危机,我们发现,针对阻塞性睡眠呼吸暂停的气道手术围手术期阿片类药物处方是持续的独立危险因素,延长,和不适当的阿片类药物使用。
AbdelwahabM,MarquesS,HowardJ,etal.睡眠呼吸暂停手术后长期使用阿片类药物的发生率和危险因素。JClinSleepMed.2022年;18(7):1805-1813。
To assess the incidence and risk factors of chronic opioid use after obstructive sleep apnea surgery.
Using IBM MarketScan research database, adults (>18 years) who underwent a variety of sleep surgery procedures between 2007 and 2015 were identified. Individuals with 1 year of insurance coverage before and after the surgical procedure were included. Additional anesthesia event(s) in the year following the procedure of interest and those who filled an opioid prescription within the year prior to surgery (not naive) were excluded. Outcomes included rates of persistent opioid use (additional opioid prescriptions filled 90-180 days postoperatively), prolonged use (additional opioid prescriptions filled 181-365 days postoperatively), and inappropriate use (> 100 morphine milligram equivalents). Evaluated variables include demographics, surgical procedures, and comorbidities.
A total of 10,766 surgical procedures met the inclusion criteria. There was a trend of increased rates of perioperative opioid prescription. After multivariable logistic regression analysis, perioperative opioid prescription and smoking were independent risk factors for inappropriate opioid use (odds ratio [OR] = 31.51, P < .001; OR = 1.41, P = .016, respectively). Opioid prescription and hypertension were independent risk factors for persistent opioid use (OR = 37.8, P < .001, OR = 1.38, P = .008). Perioperative opioid prescription, previous opioid dependence diagnosis, smoking, and male sex were associated with continuous prolonged opioid use (OR = 73.1, 8.13, 1.95, and 1.55, respectively; P < .001, P = .020, P = .024, and P = .032, respectively).
While efforts by different societies are being implemented to control the opioid crisis, we found that perioperative opioid prescription for airway surgery targeting obstructive sleep apnea is an independent risk factor for persistent, prolonged, and inappropriate opioid use.
Abdelwahab M, Marques S, Howard J, et al. Incidence and risk factors of chronic opioid use after sleep apnea surgery. J Clin Sleep Med. 2022;18(7):1805-1813.