Association of postoperative opioid type with mortality and readmission rates: multicentre retrospective cohort study.

IF 3.5 3区 医学 Q1 SURGERY BJS Open Pub Date : 2024-10-29 DOI:10.1093/bjsopen/zrae113
Stasia Winther, Espen Jimenez-Solem, Martin Sillesen
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Abstract

Background: Opioid treatment in postoperative pain management is crucial, but the impact of administration practices on outcomes is unclear. The hypothesis was that prescription trends remained stable over recent years, and that no difference in mortality and readmission risks is associated with prescription strategies.

Method: Electronic health records of surgical episodes in the Capital and Zealand Regions of Denmark from 2017 to 2021 were analysed. All opioids administered during postoperative admission were converted to oral morphine equivalents (OMEQs) and an average daily dose per patient was calculated. The opioid administered in the highest OMEQ dosages is considered the primary opioid strategy for the surgical case. Administration trends were analysed through linear regression, and Cox regression was used to calculate hazard ratios to assess dominant opioid strategies' association with 90-day mortality and readmission rates while controlling for confounders.

Results: A total of 183 317 patients met the inclusion criteria. Prescription trends remained steady during the study period. Multivariable analysis revealed increased readmission risk (HR 1.18, P < 0.001) of tramadol and tapentadol compared to morphine. They exhibited decreased 90-day mortality risk (HR 0.63, P < 0.001). Oxycodone had similar readmission risk (HR 1.009, P = 0.24) but lower 90-day mortality risk (HR 0.68, P < 0.001).

Conclusion: Postoperative in-hospital opioid administration remained stable from 2017 to 2021. Tramadol/tapentadol had a higher risk of readmission but lower mortality risk. Oxycodone had comparable readmission but reduced mortality risk. This study provides a framework for future clinical trials assessing this potential impact of opioids in a targeted manner.

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术后阿片类药物类型与死亡率和再入院率的关系:多中心回顾性队列研究。
背景:阿片类药物治疗在术后疼痛管理中至关重要,但用药方法对疗效的影响尚不清楚。假设近年来处方趋势保持稳定,死亡率和再入院风险与处方策略没有关联:方法:分析了丹麦首都地区和西兰岛地区 2017 年至 2021 年手术发作的电子健康记录。将术后入院期间使用的所有阿片类药物转换为口服吗啡当量(OMEQs),并计算出每位患者的日平均剂量。以最高 OMEQ 剂量给药的阿片类药物被视为手术病例的主要阿片类药物策略。通过线性回归分析给药趋势,并使用 Cox 回归计算危险比,以评估主要阿片类药物策略与 90 天死亡率和再入院率的关系,同时控制混杂因素:共有 183 317 名患者符合纳入标准。在研究期间,处方趋势保持稳定。多变量分析显示,与吗啡相比,曲马多和他喷他多的再入院风险增加(HR 1.18,P < 0.001)。这两种药物的90天死亡率风险降低(HR 0.63,P < 0.001)。羟考酮的再入院风险相似(HR 1.009,P = 0.24),但90天死亡风险较低(HR 0.68,P < 0.001):从2017年到2021年,术后院内阿片类药物用量保持稳定。曲马多/他喷他多的再入院风险较高,但死亡率风险较低。羟考酮的再入院风险相当,但死亡率风险降低。本研究为今后有针对性地评估阿片类药物潜在影响的临床试验提供了一个框架。
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来源期刊
BJS Open
BJS Open SURGERY-
CiteScore
6.00
自引率
3.20%
发文量
144
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