Division of Pediatric Urology, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, and Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
J Urol. 2021 Jan;205(1):264-270. doi: 10.1097/JU.0000000000001320. Epub 2020 Aug 4.
Postoperative opioids are overprescribed in the United States. In November 2016 the State of Pennsylvania required an opioid consent for minors. Our hypothesis is that this mandate decreased postoperative opioid prescriptions in our division.
All patients who received a urological outpatient or minor emergency procedure from August 2015 to August 2019 were identified. Surgeries performed within 6 months after mandate implementation were excluded to account for the transition period. Perioperative data including case type were extracted by a clinical data warehouse from preexisting fields within the health record. The frequencies of postoperative prescriptions, delayed prescriptions and emergency department encounters were assessed. A multivariable logistic regression to identify predictors of opioid prescription at discharge was performed.
A total of 4,349 patients were analyzed. The frequency of postsurgical opioid prescriptions decreased from 45.3% to 2.6% (p <0.001). The median morphine milligram equivalent decreased by 22.5 among children prescribed an opioid (p <0.001). Rates of an emergency department visits (3% vs 2.7%) or delayed nonopioid prescriptions (0.8% vs 1.2%) within 30 days of discharge were unchanged (p >0.05). Fewer patients received a delayed opioid prescription after mandate implementation (0.03% vs 0.5%, p <0.001). Female patients were less likely (OR 0.309, 95% CI 0.195-0.491; p <0.001) to receive opioids prior to but not after the mandate (OR 0.309, 95% CI 0.544-2.035; p=0.122). Increasing age was predictive of receiving an opioid before (OR 1.187, 95% CI 1.157-1.218; p <0.001) and after (OR 1.241, 95% CI 1.186-1.299; p <0.001) the mandate.
A state mandated opioid consent for minors greatly reduced post-urological surgery opioid prescription rates without increasing rates of readmission or delayed prescriptions.
美国术后阿片类药物的开具普遍存在过度的情况。2016 年 11 月，宾夕法尼亚州要求未成年人开具阿片类药物使用同意书。我们的假设是，这一要求减少了我们科室的术后阿片类药物处方。
我们确定了 2015 年 8 月至 2019 年 8 月期间接受泌尿外科门诊或未成年急诊手术的所有患者。为了考虑到过渡期，排除了在规定实施后 6 个月内进行的手术。围手术期数据，包括手术类型，通过临床数据仓库从健康记录中的现有字段中提取。评估了术后处方、延迟处方和急诊就诊的频率。对出院时开具阿片类药物处方的预测因素进行了多变量逻辑回归分析。
共分析了 4349 名患者。术后阿片类药物处方的频率从 45.3%降至 2.6%（p<0.001）。开具阿片类药物的儿童的吗啡毫克当量中位数下降了 22.5（p<0.001）。出院后 30 天内急诊就诊（3%与 2.7%）或延迟非阿片类药物处方（0.8%与 1.2%）的比例无变化（p>0.05）。规定实施后，接受延迟阿片类药物处方的患者较少（0.03%比 0.5%，p<0.001）。女性患者（OR 0.309，95%CI 0.195-0.491；p<0.001）在规定实施前而非实施后更不可能接受阿片类药物（OR 0.309，95%CI 0.544-2.035；p=0.122）。年龄增加与接受阿片类药物（OR 1.187，95%CI 1.157-1.218；p<0.001）和（OR 1.241，95%CI 1.186-1.299；p<0.001）前和后都相关。
州政府要求未成年人开具阿片类药物使用同意书，大大降低了泌尿外科手术后阿片类药物的处方率，而没有增加再入院或延迟处方的比例。
