Department of Surgery, Henry Ford Hospital, Detroit, MI, USA.
Department of Strategic and Operation Analytics, Henry Ford Hospital, Detroit MI, USA.
Am Surg. 2021 Jul;87(7):1039-1047. doi: 10.1177/0003134820956332. Epub 2020 Dec 9.
The Michigan Opioid Prescribing Engagement Network introduced guidelines in October 2017 to combat opioid overprescription following various surgical procedures. We sought to evaluate changes in opioid prescribing at our academic center and identify factors associated with nonadherence to recently implemented opioid prescribing guidelines.
This retrospective review analyzed opioid prescribing data for appendectomy, cholecystectomy, and hernia repair from January 2015 through September 2017 (pre-guidelines group) and November 2017 through December 2018 (post-guidelines group). October 2017 data were excluded to allow for guideline implementation. Opioid prescribing data were recorded as total morphine equivalents (TMEs).
Of 1493 cases (903 pre-vs. 590 post-guidelines), the mean TME prescribed significantly decreased post-guidelines (231.9 ± 108.6 vs. 112.7 ± 73.9 mg; < .01). More providers prescribed within recommended limits post-guidelines (2.8% vs. 44.8%; < .01). On multivariable analysis, independent risk factors for guideline nonadherence were the American Society of Anesthesiologists class > 2 (adjusted odds ratio [AOR]:1.65, 95% confidence interval[CI] 1.09-2.49; = .02), general surgery vs. acute care surgery service (AOR 1.89, 95% CI 1.15-3.10; = .01), oxycodone vs. hydrocodone (AOR:1.90, 95% CI:1.06-3.41; = .03), and nonphysician provider vs. resident prescriber (AOR:2.10, 95% CI:1.14-3.11; < .01).
Opioid prescribing significantly reduced after the adoption of opioid prescribing guidelines at our institution. Numerous factors associated with provider guideline nonadherence may identify actionable targets to minimize opioid overprescribing further.
密歇根州阿片类药物处方参与网络在 2017 年 10 月推出了指南，以应对各种手术后的阿片类药物过度处方问题。我们试图评估我们学术中心的阿片类药物处方变化，并确定与最近实施的阿片类药物处方指南不相符的因素。
本回顾性研究分析了 2015 年 1 月至 2017 年 9 月（指南前组）和 2017 年 11 月至 2018 年 12 月（指南后组）阑尾切除术、胆囊切除术和疝修补术的阿片类药物处方数据。2017 年 10 月的数据被排除在外，以允许实施指南。阿片类药物处方数据记录为总吗啡当量（TME）。
在 1493 例患者中（903 例指南前与 590 例指南后），指南后 TME 处方显著减少（231.9±108.6 与 112.7±73.9 mg；<0.01）。更多的医生在指南后按照建议的范围进行处方（2.8%与 44.8%；<0.01）。多变量分析显示，不遵守指南的独立危险因素包括美国麻醉医师协会（ASA）分级>2（调整后的优势比[OR]：1.65，95%置信区间[CI] 1.09-2.49；<0.01）、普通外科与急性护理外科服务（OR 1.89，95%CI 1.15-3.10；<0.01）、羟考酮与氢可酮（OR：1.90，95%CI：1.06-3.41；<0.01）和非医生提供者与住院医师处方者（OR：2.10，95%CI：1.14-3.11；<0.01）。
在我们机构采用阿片类药物处方指南后，阿片类药物的处方显著减少。许多与提供者不遵守指南相关的因素可能确定了进一步减少阿片类药物过度处方的可操作目标。
