التفاصيل البيبلوغرافية
| العنوان: |
Time-to-Cessation of Postoperative Opioids: A Population-Level Analysis of the Veterans Affairs Health Care System. |
| المؤلفون: |
Mudumbai, Seshadri C., Oliva, Elizabeth M., Lewis, Eleanor T., Trafton, Jodie, Posner, Daniel, Mariano, Edward R., Stafford, Randall S., Wagner, Todd, Clark, J. David |
| المصدر: |
Pain Medicine; Sep2016, Vol. 17 Issue 9, p1732-1743, 12p, 1 Diagram, 5 Charts, 2 Graphs |
| مصطلحات موضوعية: |
THERAPEUTIC use of narcotics, ANALGESICS, CHI-squared test, CONFIDENCE intervals, LONGITUDINAL method, VETERANS, POSTOPERATIVE pain, RESEARCH funding, STATISTICAL hypothesis testing, VISUAL analog scale, PROPORTIONAL hazards models, RETROSPECTIVE studies, DATA analysis software, DESCRIPTIVE statistics, KAPLAN-Meier estimator |
| مستخلص: |
Objective. This study aims to determine 1) the epidemiology of perioperative opioid use; and 2) the association between patterns of preoperative opioid use and time-to-cessation of postoperative opioids. Design. Retrospective, cohort study. Setting. National, population-level study of Veterans Healthcare Administration (VHA) electronic clinical data. Subjects. All VHA patients (n564,391) who underwent surgery in 2011, discharged after stays of ≥1 day, and receiving ≥1 opioid prescription within 90 days of discharge. Methods. Patients' preoperative opioid use were categorized as 1) no opioids, 2) tramadol only, 3) shortacting (SA) acute/intermittent (≤ 90 days fill), 4) SA chronic (> 90 days fill), or 5) any long-acting (LA). After defining cessation as 90 consecutive, opioidfree days, the authors calculated time-to-opioid-cessation (in days), from day 1 to day 365, after hospital discharge. The authors developed extended Cox regression models with a priori identified predictors. Sensitivity analyses used alternative cessation definitions (30 or 180 consecutive days). Results. Almost 60% of the patients received preoperative opioids: tramadol (7.5%), SA acute/intermittent (24.1%), SA chronic (17.5%), and LA (5.2%). For patients opioid-free preoperatively, median time-to-cessation of opioids postoperatively was 15 days. The SA acute/intermittent cohort (HR51.96; 95% CI51.92-2.00) had greater risk for prolonged time-to-cessation than those opioid-free (reference), but lower risk than those taking tramadol only, SA chronic (HR5 9.09; 95% CI5 8.33-9.09), or LA opioids (HR59.09; 95% CI58.33-10.00). Diagnoses of chronic pain, substance-use, or affective disorders were weaker positive predictors. Sensitivity analyses maintained findings. Conclusion. Greater preoperative levels of opioid use were associated with progressively longer time to- cessation postoperatively. [ABSTRACT FROM AUTHOR] |
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| قاعدة البيانات: |
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