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SCI 4 October 2018
Patients undergoing surgery for early-stage lung cancer often experience persistent postoperative pain; it has been estimated that in 10% of patients the pain can be so intense as to be debilitating. While the current standard of care is to prescribe opioids at discharge, this treatment is intended as short term pain control, not to exceed a few weeks after surgery. 接受早期肺癌手术的患者通常会经历持续的术后疼痛;据估计，在10%的患者中，疼痛可能会非常严重，甚至会使人虚弱。目前的治疗标准是在出院时开出阿片类药物，这种治疗方法为了短期的疼痛控制，而非对手术几周疼痛的控制。 Medical prescriptions of opioids increase the risk of opioid abuse and overdose. Video-assisted thoracoscopic surgery (VATS) is a minimally invasive surgical technique used in early stage lung cancer that might reduce the need for opioids compared with traditional open surgery, but this has yet to be established. 阿片类药物的处方增加了阿片类药物滥用和过量服用的风险。与传统的开放性手术相比，视频辅助胸腔镜手术（VATS）是一种用于早期肺癌的微创手术技术，可能会减少对阿片类药物的需求，但这还有待确立。 The Surveillance, Epidemiology, and End Results linked to the Medicare database was queried to identify patients with stage I primary non–small cell lung cancer who had VATS or open resection between January 1, 2007, to December 31, 2013, the years in which Medicare Part D data are available. 在2007年1月1日至2013年12月31日期间，在医疗保险D部分数据可用，我们对此期间的医疗保险数据库相关的监测、流行病学和最终结果进行了调查，以选定患有NSCLC并做过VATS或开放性切除术的患者。 Patients were excluded from analysis if they had a record of opioid medication prescribed in the 30 days before surgery; thus, we included only opioid-naive patients. Long term opioid use was defined as having filled 1 or more prescriptions in the first 90 days after surgery as well another prescription in the 90 and 180 days after surgery. 如果患者在手术前30天有服用阿片类药物的记录，他们就被排除在分析之外; 因此，我们只包括了体内没用阿片类药物的病人。长期服用阿片类药物的定义是，在手术后的90天内已经有了1个或更多的处方，在手术90天后到180天内又有另一个处方。 Multivariable logistic regression and propensity score matching were used to investigate the associations between surgical type and long term opioid use. Data analysis was performed between November 3, 2017, to May 15, 2018. The study was approved by Icahn School of Medicine at Mount Sinai Institutional Review Board with waiver of informed consent. 我们采用多变量逻辑回归和倾向评分匹配方法，对手术类型与长期阿片类使用之间的关系进行了研究。数据分析是在2017年11月3日至2018年5月15日之间进行的。这项研究得到了西奈山机构审查委员会中的Icahn School of Medicine的批准，豁免知情同意的要求。 There were 3900 patients with non–small cell lung cancer included in this analysis: 1987 VATS (50.9%) and 1913 open resection (49.1%) patients. A total of 2766 patients (70.9%) were discharged with an opioid prescription, and 603 (15.5%) patients had a record of long-term postoperative use. Patients who underwent VATS were more likely to be women; older; have a smaller tumor, adenocarcinoma, limited resection, and a lower comorbidity score; belong to a higher income quartile; and live in an urban area. 在此分析中，有3900名非小细胞肺癌患者：1987例VATS（50.9%）和1913例开放性切除（49.1%）患者。共有2766名患者（70.9%）服用阿片类药物，603名（15.5%）患者有长期术后使用的记录。接受过VATS的病人多为年长的，有一较小肿瘤，腺癌，有限的切除，较少伴随疾病，属于高收入，住在城市里的女性。 Patients who underwent VATS were significantly less likely to have filled an opioid prescription within 90 days after surgery, had a smaller number of overall opioid prescriptions filled than open resection patients, and were less likely to be long-term opioid users (Table 1). In the adjusted model, patients were significantly less likely to use opioids long-term if they had VATS (adjusted odds ratio [aOR], 0.69; 95%CI, 0.57-0.84), were older (aOR, 0.96, 95% CI0.94-0.98), and had higher income (aOR,0.77, 95% CI, 0.60-0.99). 接受过VATS的患者在手术后90天内服用阿片类药物的可能性要小得多，他们的阿片类处方量比开放式切除患者的要少，而且不太可能是长期服用阿片类药物的人。在调整后的模型中，如果患者施行VATS（调整后的概率比[aOR]，0.69; 95%CI，0.57-0.84），年龄较大（aOR，0.96，95%CI 0.94-0.98），并且有较高的收入（aOR，0.77，95%CI，0.60-0.99）那么长期使用阿片类药物的可能性就会大大降低。 Long-term opioid use was significantly more likely in those with a higher comorbidity score (aOR, 1.10; 95%CI, 1.05- 1.16), large-cell histology (aOR, 1.88; 95%CI, 1.17-3.00), using sleep medication 30 days before surgery (aOR, 1.72; 95% CI, 1.28-2.32), and with a previous psychiatric condition (aOR, 1.64; 95%CI, 1.28-2.09). After propensity matching, the risk of long term opioid use was still significantly less in patients who underwent VATS (aOR, 0.52; 95% CI, 0.36-0.75) 长期服用阿片类药物的人更有可能在有更多的伴随症状（aOR，1.10;95%CI，1.05-1.16），大细胞的组织学特征（aOR，1.88 95%CI, 1.17-3.00)，在手术前30天使用安眠药（aOR，1.72;95%CI，1.28-2.32）和先前有精神状况（aOR，1.64;95%CI,1.28-2.09)的人中。在倾向匹配之后，在接受VATS（aOR，0.52;95%CI,0.36 --0.75)的人中，长期服用阿片类药物的患者依然明显更少。 A total of 15.5% of patients who were not previous opioid users became long-term opioid users after surgery. Our study suggests that surgical invasiveness might play a role in the odds of becoming a long-term opioid user after surgery; patients undergoing VATS were less likely to use opioids both in the immediate postoperative period and long-term, even after adjusting for relevant covariates. A limitation of this claim based study is the precision of the measurement: we cannot discount, for example, that patients may have been able to acquire opioids from friends or family members. 共有15.5%的非阿片类药物使用者在手术后成为长期的阿片类使用者。我们的研究表明，外科手术的侵入程度可能会在手术后成为一个长期的阿片类使用者的可能性中发挥作用; 即使在调整了相关的协变量之后，接受VATS的患者在术后和之后长期使用阿片类药物的可能性较低。这种基于索赔的研究的一个局限性在于测量的精确性：例如，我们不能低估患者可能从朋友或家庭成员那里获得阿片类药物。 However, this possibility suggests that we are likely underestimating the true proportion of long-term opioid users. The escalating severity of the opioid epidemic in the United States highlights the need for additional research into how pain management after surgery might be a contributing factor. 然而，这种可能性表明，我们反而很可能低估了长期阿片类用户的真实比例。美国阿片类流行病的严重程度不断上升，凸显出对术后的疼痛控制的需要，这可能会促进进一步的研究。 喜欢SCI天天读的理由 陪您一起学习SCI医学论文 每天5分钟，让自己的英语牛逼起来 特殊福利让您惊喜连连 |
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来自： rodneyzhang > 《肿瘤》
