Objective: 

To determine: (1) incidence of “opioid never events” (ONEs), defined as the development of opioid dependence or overdose in an opioid-naive surgical patient who is prescribed opioids postoperatively and (2) risk factors predicting ONEs.

Background: 

Patients receiving opioids after surgery are at risk of experiencing life-threatening opioid-related adverse events.

Methods: 

An electronic medical record review identified surgical patients at an academic medical center between January 1, 2015, and December 31, 2018, followed through March 31, 2020. ONEs were determined by International Classification of Diseases, Ninth/10th Revision (ICD-9/10) codes, and electronic medical record review.

Results: 

A total of 35,335 opioid-naive surgical patients received a perioperative opioid prescription. The median follow-up was 3.47 years (range: 1.25–5.25 years). ONEs occurred in 0.19% (67/35,335) of patients. The ONE rate was 5.6 per 10,000 person-years of follow-up. Ten of 67 ONE patients overdosed on opioids. The median time to ONE was 1.6 years; the highest ONE rate was observed 1 to 2 years after surgery. In multivariate analysis, patients receiving opioid prescriptions 90 to 180 or 90 to 360 days after surgery had the highest risk of developing ONEs [hazard ratio (HR)=6.39, confidence interval (CI): 3.72–10.973; HR=6.87, CI: 4.24–11.12, respectively]. Surgical specialty (HR=5.21, 2.65–0.23) and patient age (HR=4.17, CI: 2.50–6.96) were also risk factors for ONEs. Persistent opioid use 90 to 360 days after surgery was present in 45% of patients developing ONEs.

Conclusions: 

Postoperative opioid dependence or overdose is a significant health problem, affecting roughly 2 per 1000 opioid-naive surgical patients prescribed an opioid and followed for 5 years. Risk factors for the development of ONEs include opioid use 3 to 12 months after surgery, patient age, and surgical procedure.

中文翻译：

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手术后阿片类药物依赖和过量：发生率、风险因素和原因

客观的： 

确定：（1）“阿片类药物从不事件”（ONEs）的发生率，定义为阿片类药物初治手术患者术后出现阿片类药物依赖或过量服用；（2）预测 ONEs 的风险因素。

背景： 

手术后接受阿片类药物的患者有发生危及生命的阿片类药物相关不良事件的风险。

方法： 

电子病历审查确定了 2015 年 1 月 1 日至 2018 年 12 月 31 日期间在学术医疗中心接受手术的患者，随后至 2020 年 3 月 31 日。ONE 由国际疾病分类第九/第十修订版(ICD-9/ 10) 代码和电子病历审查。

结果： 

共有 35,335 名未接受过阿片类药物手术的患者在围手术期接受了阿片类药物处方。中位随访时间为 3.47 年（范围：1.25-5.25 年）。ONEs 发生在 0.19% (67/35,335) 的患者中。ONE 率为 5.6/10,000 人年的随访。67 名 ONE 患者中有 10 名过量服用阿片类药物。ONE 的中位时间为 1.6 年；术后1 至 2 年观察到最高 ONE 率。在多变量分析中，患者在术后90 至 180 天或 90 至 360 天接受阿片类药物处方发生 ONE 的风险最高 [风险比 (HR) = 6.39，置信区间 (CI)：3.72–10.973；HR=6.87，CI：4.24-11.12，分别]。外科专业 (HR=5.21, 2.65–0.23) 和患者年龄 (HR=4.17, CI: 2.50–6.96) 也是 ONEs 的危险因素。45% 的 ONE 患者在手术后 90 至 360 天持续使用阿片类药物。

结论： 

术后阿片类药物依赖或过量是一个严重的健康问题，每 1000 名未接受过阿片类药物手术的患者中约有 2 名接受过阿片类药物处方并随访 5 年。ONEs 发展的风险因素包括手术后 3 至 12 个月的阿片类药物使用、患者年龄和手术过程。