在成年人手术后持续使用新型阿片类药物的预测因素
Kathryn H Gessner1, John S Preisser2,3, Emily Pfaff4
1Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA.
概括
在手术后识别患有持续阿片类药物使用风险的患者至关重要. 这项研究发现,并发症和地理因素预测阿片类药物使用,尽管添加地理数据并没有显著改善预测模型.
科学领域:
- 医疗信息学 医疗信息学
- 公共卫生 公共卫生
- 疼痛管理 疼痛管理
背景情况:
- 持续使用阿片类药物是一种重要的术后并发症.
- 早期识别有风险的患者对于干预至关重要.
- 目前的预测模型通常仅依赖电子健康记录 (EHR) 和索赔数据.
研究的目的:
- 开发一个持续的术后阿片类药物使用的预测模型.
- 评估是否结合地理因素可以提高预测准确度.
- 通过术前风险识别来减少术后阿片类药物的使用.
主要方法:
- 利用了来自北卡罗来纳州4116名未使用过阿片类药物的外科手术患者的EHR和索赔数据.
- 关于失业和阿片类药物相关结果的社区层面综合数据.
- 使用多变量后勤回归和蒙特卡洛交叉验证来评估风险因素和模型性能.
主要成果:
- 6.0%的患者出现了新的持续性阿片类药物使用.
- 关键预测因素包括年龄,背部/部疼痛,关节疾病,情绪障碍,先前的阿片类药物处方和局部药物中毒率.
- 添加地理因素显示模型预测的适度,非显著的改善 (AUC 0.667与0.653).
结论:
- 患者的并发症和基于地区的社会经济因素是持续的术后阿片类药物使用的重要预测因素.
- 虽然地理因素显示出潜力,但它们并没有显著提高仅基于EHR和索赔数据的模型的预测能力.
- 需要更大的数据集来最终评估地理因素对预测模型性能的影响.
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