risk factors for POU in opioid-naïve patients undergoing surgery in all NZ hospitals. METHOD: We included all opioid-naïve patients who underwent surgery without a concomitant trauma diagnosis and received opioids after discharge from any NZ hospital between January 2007 and December 2019. Patients were considered opioid naïve if no opioids had been dispensed to them or if they did not have a prior diagnosis of an opioid-use disorder up to 365 days preceding the index date. The primary outcome was the incidence of POU, defined a priori as opioid use after discharge between 91 and 365 days. We used a multivariable logistic regression to identify risk factors for POU. RESULTS: We identified 1789,407 patients undergoing surgery with no concomitant diagnosis of trauma; 377,144 (21.1%) were dispensed opioids and 260,726 patients were eligible and included in the analysis. Of those included in the final sample, 23,656 (9.1%; 95% confidence interval [CI], 9.0%–9.2%) developed POU. Risk factors related to how opioids were prescribed included: changing to different opioid(s) after discharge (adjusted odds ratio [aOR], 3.21; 95% CI, 3.04–3.38), receiving multiple opioids on discharge (aOR, 1.37; 95% CI, 1.29–1.45), and higher total oral morphine equivalents (>400 mg) (aOR, 1.23; 95% CI, 1.23–1.45). Conversely, patients who were coprescribed nonopioid analgesics on discharge had lower odds of POU (aOR, 0.91; 95% CI, 0.87–0.95). Only small differences were observed between different ethnicities. Other risk factors associated with increased risk of POU included undergoing neurosurgery (aOR, 2.02; 95% CI, 1.83–2.24), higher comorbidity burden (aOR, 1.90; 95% CI, 1.75–2.07), preoperative nonopioid analgesic use (aOR, 1.65; 95% CI, 1.60–1.71), smoking (aOR, 1.44; 95% CI, 1.35–1.54), and preoperative hypnotics use (aOR, 1.35; 95% CI, 1.28–1.42). CONCLUSIONS: Approximately 1 in 11 opioid-naïve patients who were dispensed opioids on surgical discharge, developed POU. Potentially modifiable risk factors for POU, related to how opioids were prescribed included changing opioids after discharge, receiving multiple opioids, and higher total dose of opioids given on discharge. Clinicians should discuss the possibility of developing POU with patients before and after surgery and consider potentially modifiable risk factors for POU when prescribing analgesia on discharge after surgery....

中文翻译：

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新西兰手术入院后持续使用阿片类药物：一项基于人群的研究


在新西兰所有医院接受手术的未使用过阿片类药物的患者发生 POU 的危险因素。方法：我们纳入了所有在 2007 年 1 月至 2019 年 12 月期间从新西兰任何一家医院出院后接受阿片类药物治疗且没有伴随创伤诊断的患者。在索引日期之前 365 天内没有事先诊断出阿片类药物使用障碍。主要结局是 POU 的发生率，先验定义为出院后 91 至 365 天内使用阿片类药物。我们使用多变量逻辑回归来确定 POU 的风险因素。结果：我们确定了 1789,407 名接受手术且没有伴随创伤诊断的患者； 377,144 名患者（21.1%）被分配了阿片类药物，260,726 名患者符合条件并纳入分析。在最终样本中，有 23,656 人（9.1%；95% 置信区间 [CI]，9.0%–9.2%）出现了 POU。与阿片类药物处方方式相关的风险因素包括：出院后更换为不同的阿片类药物（调整后比值比 [aOR]，3.21；95% CI，3.04–3.38）、出院时接受多种阿片类药物（aOR，1.37；95%） CI，1.29–1.45），以及更高的口服吗啡总当量（>400 mg）（aOR，1.23；95% CI，1.23–1.45）。相反，出院时同时服用非阿片类镇痛药的患者发生 POU 的几率较低（aOR，0.91；95% CI，0.87-0.95）。不同种族之间仅观察到很小的差异。与 POU 风险增加相关的其他危险因素包括接受神经外科手术（aOR，2.02；95% CI，1.83-2.24）、较高的合并症负担（aOR，1.90；95% CI，1.75-2.07）、术前使用非阿片类镇痛药（aOR， 1.65；95% CI，1.60–1.71），吸烟（aOR，1.44；95% CI，1.35–1。54），以及术前催眠药的使用（aOR，1.35；95% CI，1.28-1.42）。结论：在手术出院时分配阿片类药物的 11 名从未使用过阿片类药物的患者中，大约有 1 名患者出现了 POU。与阿片类药物处方方式相关的 POU 潜在可改变危险因素包括出院后更换阿片类药物、接受多种阿片类药物以及出院时给予较高的阿片类药物总剂量。临床医生应在手术前后与患者讨论发生 POU 的可能性，并在术后出院时给予镇痛处方时考虑 POU 的潜在可改变危险因素。