From the Department of Orthopaedic Surgery, MetroHealth Medical Center, Cleveland, OH, affiliated with Case Western Reserve University.
J Am Acad Orthop Surg Glob Res Rev. 2020 Aug;4(8):e20.00134. doi: 10.5435/JAAOSGlobal-D-20-00134.
Legislatures across the country are passing new opioid prescribing laws. To understand the effects of this legislation, baseline autonomous shifts in physician opioid prescribing must be evaluated.
The purpose of this retrospective dual cohort comparison study was to evaluate 5-year opioid prescribing trends in orthopaedic trauma patients. Demographic and injury information were collected on adult trauma patients with surgically managed orthopaedic fractures from 2012 (N = 190) and 2017 (N = 160). The amount of opioid medication prescribed from discharge to 1 year after the injury was collected. Opioid prescriptions were converted to morphine milligram equivalents (MMEs). The main outcome measure was opioid medication prescribed in 2017 versus 2012.
The cohorts were well-matched on sex, race, medical comorbidities, substance use, fracture location, Injury Severity Score, hospital length of stay, and intensive care unit admission metrics. However, the 2012 cohort was older than the 2017 cohort (51.9 versus 43.3 years, P < 0.001). When controlling for age, total opioid medication prescribed was greater in 2012 than in 2017 (1,680 versus 1,110 MME, P = 0.001). Patients in 2017 received both lower discharge prescriptions (523 versus 407 MME, P < 0.001) and lower total opioid prescription refill amounts (1,140 versus 766 MME, P = 0.037). The number of refills prescribed was equal, but patients received lower amounts of opioid medications per refill in 2017 (333 versus 243 MME, P < 0.001). Despite these differences, the percentage of patients ceasing prescription opioid use 1 year after injury was unchanged (90.6% versus 92.1%, P = 0.675).
Over 5 years, providers have successfully reduced the amount of opioid medication prescribed to surgically managed orthopaedic trauma patients through self-directed measures. The effects of opioid prescribing legislation should be viewed from this baseline.
全美各地的立法机构都在通过新的阿片类药物处方法规。为了了解这些法规的影响，必须评估医生自主调整阿片类药物处方的基线变化。
本回顾性双队列比较研究旨在评估 2012 年（N=190）和 2017 年（N=160）接受手术治疗的骨科创伤患者 5 年阿片类药物处方趋势。收集了接受手术治疗的成人创伤患者的人口统计学和损伤信息，包括骨折部位、损伤严重程度评分、住院时间和入住重症监护病房的情况。主要观察指标为 2017 年与 2012 年的阿片类药物处方量。
两个队列在性别、种族、合并症、药物滥用、骨折部位、损伤严重程度评分、住院时间和入住重症监护病房的情况方面匹配良好。然而，2012 年队列的年龄大于 2017 年队列（51.9 岁比 43.3 岁，P＜0.001）。控制年龄因素后，2012 年的总阿片类药物处方量大于 2017 年（1680 毫克吗啡当量比 1110 毫克吗啡当量，P=0.001）。2017 年患者的出院处方量（523 毫克吗啡当量比 407 毫克吗啡当量，P＜0.001）和总阿片类药物处方补充量（1140 毫克吗啡当量比 766 毫克吗啡当量，P=0.037）均较低。尽管如此，2017 年患者的处方阿片类药物补充量相等，但每剂药物的剂量较低（333 毫克吗啡当量比 243 毫克吗啡当量，P＜0.001）。尽管存在这些差异，但 1 年后停止使用处方阿片类药物的患者比例仍保持不变（90.6%比 92.1%，P=0.675）。
在过去的 5 年中，通过自我指导措施，医疗服务提供者成功减少了接受手术治疗的骨科创伤患者的阿片类药物处方量。应该从这个基线水平来评估阿片类药物处方法规的效果。
