在德国，术后持续使用阿片类药物（PPOU）的风险及其与手术类型的关系尚不清楚。我们根据德国法定健康保险公司 BARMER 的索赔数据进行了一项全国范围的回顾性队列研究。该研究纳入了未患癌症且在 2018 年接受住院手术的未使用过阿片类药物的成年人。操作分为103类。 PPOU 被定义为术后第 1 天至 90 天以及出​​院后第 91 天至 180 天之间开出阿片类药物处方。调查患者术前12个月内的相关危险因素，共纳入203 327例患者。 1.4% 患有 PPOU（95% 置信区间 [1.4; 1.5]）。手术组之间存在重大差异：大截肢和矫形手术对发生 PPOU 的风险最大。手术类型对 PPOU 风险的影响比先前存在的风险因素更大（解释方差分别为 22.3% 和 14.3%）。在这些因素中，酗酒和既往接受抗抑郁药物治疗与 PPOU 风险最高相关（比值比 [OR] 1.515 [1.277; 1.797] 和 2.131 [1.943; 2.336]）。德国 PPOU 的发病率是低（1.4%）。手术类型对其发展起着重要作用。

The risk of persistent postoperative opioid use (PPOU) and its association with the type of surgery are still unclear in Germany.We conducted a nationwide retrospective cohort study on the basis of claims data from BARMER, a statutory health insurance carrier in Germany. Opioid-naive adults who did not have cancer and who underwent inpatient surgery in 2018 were included in the study. The operations were divided into 103 categories. PPOU was defined as the prescribing of opioids between postoperative days 1 and 90 and also between postoperative days 91 and 180 after hospital discharge. Patient-associated risk factors in the 12 months before surgery were investigated.203 327 patients were included. 1.4% had PPOU (95% confidence interval [1.4; 1.5]). There were major differences between operation groups: major amputations and orthopedic procedures carried the greatest risk for the development of PPOU. The type of surgery had a larger effect on the risk of PPOU than pre-existing risk factors (explained variance 22.3% vs. 14.3%). Among such factors, alcohol abuse and pre-existing treatment with antidepressant drugs were associated with the highest risk for PPOU (odds ratios [OR] 1.515 [1.277; 1.797] and 2.131 [1.943; 2.336]).The incidence of PPOU in Germany is low (1.4%). The type of surgery plays an important role in its development.