高风险处方增加全髋关节置换术患者新持续性阿片类药物使用的风险。
High-Risk Prescribing Increases Rates of New Persistent Opioid Use in Total Hip Arthroplasty Patients.
机构信息
University of Michigan Medical School, Ann Arbor, MI.
Department of Surgery, University of Michigan, Ann Arbor MI; Michigan Opioid Prescribing Engagement Network, Ann Arbor, MI.
出版信息
J Arthroplasty. 2020 Sep;35(9):2472-2479.e2. doi: 10.1016/j.arth.2020.04.019. Epub 2020 Apr 14.
BACKGROUND
The association between surgeon prescribing practices and new persistent postoperative opioid use is not well understood. We examined the association between surgeon prescribing and new persistent use among total hip arthroplasty (THA) patients.
METHODS
A retrospective analysis of Medicare claims in Michigan was performed. The study cohort consisted of orthopedic surgeons performing THAs from 2013 to 2016 and their opioid-naïve patients, aged >65 years. High-risk prescribing included high daily doses, overlapping benzodiazepine prescriptions, concurrent opioid prescriptions, prescriptions from multiple providers, or long-acting opioid prescriptions. The occurrence of a preoperative prescription, initial prescription size, and 30-day prescription dosage were examined as individual exposures. Surgeons were categorized into quartiles by prescribing practices, and multilevel hierarchical logistic regression was used to examine associations with postoperative new persistent opioid use.
RESULTS
Surgeons exhibited high-risk prescribing for 66% of encounters. Patients of surgeons with the highest rates of high-risk prescribing were more likely to develop persistent use compared with patients of surgeons with the lowest rates (adjusted rates: 9.7% vs 4.6%, P = .011). Patients of surgeons with initial prescription sizes in the "high" (third) quartile (adjusted odds ratio, 2.91; 95% confidence interval, 1.53-5.51), and of surgeons in the "highest" (fourth) quartile of 30-day prescription dosage (adjusted odds ratio, 1.93; 95% confidence interval, 1.03-3.61), were more likely to develop persistent opioid use compared with patients of surgeons with low initial and 30-day prescription sizes, respectively.
CONCLUSION
The development of persistent opioid use after surgery is multifactorial, and surgeon prescribing patterns play an important role. Reducing prescribing and encouraging opioid alternatives could minimize postoperative persistent opioid use.
背景
外科医生的处方实践与新的持续性术后阿片类药物使用之间的关联尚不清楚。我们研究了全髋关节置换术（THA）患者中外科医生处方与新的持续性使用之间的关联。
方法
对密歇根州的医疗保险索赔进行了回顾性分析。研究队列包括 2013 年至 2016 年进行 THA 的骨科医生及其无阿片类药物使用史的患者，年龄>65 岁。高风险处方包括高日剂量、重叠苯二氮䓬类药物处方、同时开阿片类药物处方、由多个提供者开处方或开长效阿片类药物处方。研究了术前处方、初始处方大小和 30 天处方剂量作为个体暴露因素。根据处方实践将外科医生分为四组，并使用多级分层逻辑回归来检查与术后新的持续性阿片类药物使用相关的关联。
结果
外科医生的处方中有 66%属于高风险处方。与处方风险最低的外科医生的患者相比，处方风险最高的外科医生的患者更有可能发展为持续性使用（调整后的发生率：9.7%比 4.6%，P=0.011）。初始处方大小处于“高”（第三）四分位数的外科医生的患者（调整后的比值比，2.91；95%置信区间，1.53-5.51），以及初始处方大小处于“最高”（第四）四分位数且 30 天处方剂量较高的外科医生的患者（调整后的比值比，1.93；95%置信区间，1.03-3.61），与初始处方大小较低的外科医生的患者相比，更有可能发展为持续性阿片类药物使用。
结论
手术后持续性阿片类药物使用的发生是多因素的，外科医生的处方模式起着重要作用。减少处方并鼓励使用阿片类药物替代品可能会最大限度地减少术后持续性阿片类药物使用。
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