青少年特发性脊柱侧弯后路脊柱融合术后的阿片类药物处方实践。
Opioid prescribing practices after posterior spinal arthrodesis for adolescent idiopathic scoliosis.
作者信息
Harris Andrew B, Puvanesarajah Varun, Marrache Majd, Gottlich Caleb P, Raad Micheal, Skolasky Richard L, Njoku Dolores B, Sponseller Paul D, Jain Amit
机构信息
Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, Baltimore, MD, JHOC 5223, 21287, USA.
Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University, Baltimore, MD, USA.
出版信息
Spine Deform. 2020 Oct;8(5):965-973. doi: 10.1007/s43390-020-00127-z. Epub 2020 May 6.
STUDY DESIGN
Retrospective review.
OBJECTIVE
To identify national trends in postoperative opioid prescribing practices after posterior spinal fusion (PSF) in patients with adolescent idiopathic scoliosis (AIS). Opioids are an important component of pain management after PSF for AIS. Given the national opioid crisis, it is important to understand opioid prescribing practices in these patients.
METHODS
Using a commercial prescription drug claims database, we identified AIS patients who underwent PSF from 2010 to 2016 and who were prescribed opioids postoperatively. An initial prescription at hospital discharge of ≥ 90 morphine milligram equivalents daily (MMED) was used to identify patients at risk of overdose according to the US Centers for Disease Control and Prevention (CDC) guidelines. Prescriptions for skeletal muscle relaxants were also identified. α = 0.05.
RESULTS
We included 3762 patients (75% female) with a mean (± standard deviation) age of 15 ± 2.1 years. 56% of patients filled only 1 opioid prescription after discharge, and 44% had ≥ 1 refills. 91% of opioid prescriptions were for hydrocodone (median strength, 43 MMED; mean strength, 65 ± 270 MMED) or oxycodone formulations (median strength, 60 MMED; mean strength, 79 ± 174 MMED). 82% of prescriptions complied with CDC guidelines (< 90 MMED). Overall, 612 patients (16%) filled ≥ 1 prescription for skeletal muscle relaxants, the most common being cyclobenzaprine (45%) and methocarbamol (29%). The percentage of patients filling > 1 prescription declined from 54% in 2010 to 31% in 2016 (p < 0.001). The proportion of patients receiving prescriptions for ≥ 90 MMED was highest in the West (29%) and lowest in the South (16%) (p < 0.001).
CONCLUSION
Most opioid prescriptions after PSF in patients with AIS comply with CDC guidelines. Temporal and geographic variations show an opportunity for standardizing opioid prescribing practices in these patients.
LEVEL OF EVIDENCE
III.
研究设计
回顾性研究。
目的
确定青少年特发性脊柱侧弯（AIS）患者后路脊柱融合术（PSF）后术后阿片类药物处方的全国趋势。阿片类药物是AIS患者PSF术后疼痛管理的重要组成部分。鉴于全国性的阿片类药物危机，了解这些患者的阿片类药物处方做法很重要。
方法
使用商业处方药索赔数据库，我们确定了2010年至2016年接受PSF且术后开具阿片类药物处方的AIS患者。根据美国疾病控制与预防中心（CDC）指南，出院时初始处方每日≥90毫克吗啡当量（MMED）用于识别有过量用药风险的患者。还确定了骨骼肌松弛剂的处方。α = 0.05。
结果
我们纳入了3762例患者（75%为女性），平均（±标准差）年龄为15±2.1岁。56%的患者出院后仅开具了1份阿片类药物处方，44%的患者有≥1次续方。91%的阿片类药物处方为氢可酮（中位强度，43 MMED；平均强度，65±270 MMED）或羟考酮制剂（中位强度，60 MMED；平均强度，79±174 MMED）。82%的处方符合CDC指南（<90 MMED）。总体而言，612例患者（16%）开具了≥1份骨骼肌松弛剂处方，最常见的是环苯扎林（45%）和甲氯芬那酸（29%）。开具>1份处方的患者比例从2010年的54%下降至2016年的31%（p<0.001）。接受≥90 MMED处方的患者比例在西部最高（29%），在南部最低（16%）（p<0.001）。
结论
AIS患者PSF术后的大多数阿片类药物处方符合CDC指南。时间和地域差异表明有机会规范这些患者的阿片类药物处方做法。
证据级别
III级。
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