Center for Surgery and Public Health, Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
JAMA Surg. 2018 Jan 1;153(1):37-43. doi: 10.1001/jamasurg.2017.3132.
The overprescription of pain medications has been implicated as a driver of the burgeoning opioid epidemic; however, few guidelines exist regarding the appropriateness of opioid pain medication prescriptions after surgery.
To describe patterns of opioid pain medication prescriptions after common surgical procedures and determine the appropriateness of the prescription as indicated by the rate of refills.
DESIGN, SETTING, AND PARTICIPANTS: The Department of Defense Military Health System Data Repository was used to identify opioid-naive individuals 18 to 64 years of age who had undergone 1 of 8 common surgical procedures between January 1, 2005, and September 30, 2014. The adjusted risk of refilling an opioid prescription based on the number of days of initial prescription was modeled using a generalized additive model with spline smoothing.
Length of initial prescription for opioid pain medication.
Need for an additional subsequent prescription for opioid pain medication, or a refill.
Of the 215 140 individuals (107 588 women and 107 552 men; mean [SD] age, 40.1 [12.8] years) who underwent a procedure within the study time frame and received and filled at least 1 prescription for opioid pain medication within 14 days of their index procedure, 41 107 (19.1%) received at least 1 refill prescription. The median prescription lengths were 4 days (interquartile range [IQR], 3-5 days) for appendectomy and cholecystectomy, 5 days (IQR, 3-6 days) for inguinal hernia repair, 4 days (IQR, 3-5 days) for hysterectomy, 5 days (IQR, 3-6 days) for mastectomy, 5 days (IQR, 4-8 days) for anterior cruciate ligament repair and rotator cuff repair, and 7 days (IQR, 5-10 days) for discectomy. The early nadir in the probability of refill was at an initial prescription of 9 days for general surgery procedures (probability of refill, 10.7%), 13 days for women's health procedures (probability of refill, 16.8%), and 15 days for musculoskeletal procedures (probability of refill, 32.5%).
Ideally, opioid prescriptions after surgery should balance adequate pain management against the duration of treatment. In practice, the optimal length of opioid prescriptions lies between the observed median prescription length and the early nadir, or 4 to 9 days for general surgery procedures, 4 to 13 days for women's health procedures, and 6 to 15 days for musculoskeletal procedures.
阿片类药物的过度处方被认为是阿片类药物流行的一个驱动因素;然而，关于手术后阿片类药物处方的适当性，几乎没有指导方针。
描述常见手术术后阿片类药物止痛处方的模式，并根据处方的续方率来确定其适当性。
设计、设置和参与者：利用 2005 年 1 月 1 日至 2014 年 9 月 30 日期间接受 8 种常见手术之一的 18 至 64 岁阿片类药物初治个体的美国国防部军事卫生系统数据库，建立模型，采用广义加性模型和样条平滑来确定初始处方天数与阿片类药物处方续方之间的调整风险比。
阿片类药物止痛初始处方的长度。
需要额外的后续阿片类药物止痛处方或续方。
在研究期间接受手术并在指数手术后 14 天内至少开具并填写 1 份阿片类药物止痛处方的 215140 名个体中（107588 名女性和 107552 名男性；平均[标准差]年龄 40.1[12.8]岁），41107 名（19.1%）至少开具了 1 份续方。阑尾切除术和胆囊切除术的中位处方长度为 4 天（四分位间距[IQR]，3-5 天），腹股沟疝修补术为 5 天（IQR，3-6 天），子宫切除术为 4 天（IQR，3-5 天），乳房切除术为 5 天（IQR，4-8 天），前交叉韧带修复术和肩袖修复术为 5 天（IQR，4-8 天），椎间盘切除术为 7 天（IQR，5-10 天）。续方概率的早期最低点出现在普外科手术的初始处方为 9 天（续方概率为 10.7%），妇科手术为 13 天（续方概率为 16.8%），肌肉骨骼手术为 15 天（续方概率为 32.5%）。
理想情况下，手术后的阿片类药物处方应在适当的疼痛管理和治疗持续时间之间取得平衡。实际上，阿片类药物处方的最佳长度介于观察到的中位处方长度和早期最低点之间，即普外科手术为 4 至 9 天，妇科手术为 4 至 13 天，肌肉骨骼手术为 6 至 15 天。
