Background:Prescription opioids are a major contributor to the ongoing epidemic of persistent opioid use (POU). The incidence of POU among opioid-naïve patients after cardiac implantable electronic device (CIED) procedures is unknown.Methods:This retrospective cohort study used data from a national administrative claims database from 2004 to 2018 of patients undergoing CIED procedures. Adult patients were included if they were opioid-naïve during the 180-day period before the procedure and did not undergo another procedure with anesthesia in the next 180 days. POU was defined by filling an additional opioid prescription >30 days after the CIED procedure.Results:Of the 143 400 patients who met the inclusion criteria, 15 316 (11%) filled an opioid prescription within 14 days of surgery. Among these patients, POU occurred in 1901 (12.4%) patients 30 to 180 days after surgery. The likelihood of developing POU was increased for patients who had a history of drug abuse (odds ratio, 1.52; P=0.005), preoperative muscle relaxant (odds ratio, 1.52; P<0.001) or benzodiazepine (odds ratio, 1.23; P=0.001) use, or opioid use in the previous 5 years (OR, 1.76; P<0.0001). POU did not differ after subcutaneous implantable cardioverter defibrillator or other CIED procedures (11.1 versus 12.4%; P=0.5). In a sensitivity analysis excluding high-risk patients who were discharged to a facility or who had a history of drug abuse or previous opioid, benzodiazepine, or muscle relaxant use, 8.9% of the remaining cohort had POU. Patients prescribed >135 mg of oral morphine equivalents had a significantly increased risk of POU.Conclusions:POU is common after CIED procedures, and 12% of patients continued to use opioids >30 days after surgery. Higher initially prescribed oral morphine equivalent doses were associated with developing POU.

中文翻译：

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心脏植入式电子设备手术后持续使用阿片类药物

背景：处方阿片类药物是持续性阿片类药物使用 (POU) 持续流行的主要原因。心脏植入式电子设备 (CIED) 手术后未使用阿片类药物的患者中 POU 的发生率尚不清楚。如果成年患者在手术前的 180 天内未使用过阿片类药物，并且在接下来的 180 天内未接受另一次麻醉手术，则包括在内。POU 的定义是在 CIED 手术后 30 天以上再开阿片类药物处方。结果：在符合纳入标准的 143 400 名患者中，15 316 名（11%）在手术后 14 天内开出了阿片类药物处方。在这些患者中，POU 发生在 1901 年（12. 4%) 术后 30 至 180 天的患者。有药物滥用史的患者发生 POU 的可能性增加（优势比，1.52；P = 0.005），术前使用肌肉松弛剂（优势比，1.52；P <0.001）或苯二氮卓（优势比，1.23；P = 0.001），或在过去 5 年内使用阿片类药物（OR，1.76；P <0.0001）。皮下植入式心律转复除颤器或其他 CIED 手术后 POU 没有差异（11.1% vs 12.4%；P=0.5）。在排除出院或有药物滥用史或既往使用阿片类药物、苯二氮卓类药物或肌肉松弛剂的高危患者的敏感性分析中，其余队列中有 8.9% 患有 POU。处方 > 135 mg 口服吗啡等价物的患者发生 POU 的风险显着增加。结论：POU 在 CIED 手术后很常见，12% 的患者在手术后 30 天后继续使用阿片类药物。较高的初始处方口服吗啡等效剂量与发生 POU 相关。