Bisson Leslie J, Kluczynski Melissa A, Intrieri Kevin M, Bisson Rian C, Del Prince Clayton
Jacobs School of Medicine & Biomedical Sciences, State University of New York, University at Buffalo, Buffalo, New York.
JB JS Open Access. 2021 May 4;6(2). doi: 10.2106/JBJS.OA.20.00138. eCollection 2021 Apr-Jun.
Interventions designed to decrease opioid prescribing in orthopaedics have been effective when employed by specific institutions, subspecialties, and procedures. The objectives of this study were to examine the effectiveness of developing regional guidelines on opioid-prescribing practices after common orthopaedic surgical procedures, to determine whether compliance with the guidelines varied by procedure, and to measure the effect of the guidelines on patient satisfaction. All objectives were assessed at 1 participating institution.
In February 2018, 53 orthopaedic surgeons representing 8 practices in Western New York attended a summit meeting to collaboratively create regional opioid-prescribing guidelines for 70 common orthopaedic procedures; these guidelines were later distributed electronically to all orthopaedists in Western New York. We retrospectively examined opioid-prescribing practices for adults undergoing an orthopaedic surgical procedure performed by 1 large practice in October 2017, 4 months before the summit meeting (776 patients), and in July 2018, 5 months after the summit meeting (653 patients). The number of opioid pills prescribed postoperatively and patient satisfaction were compared before and after the summit meeting using t tests.
The overall mean number of opioid pills (and standard deviation) prescribed postoperatively decreased from 69.5 ± 45.5 pills before the summit to 43.3 ± 28.0 pills after the summit (p < 0.0001). Sports medicine surgeons reduced the number of pills prescribed for anterior cruciate ligament reconstruction, arthroscopic rotator cuff repair, knee arthroscopy with meniscectomy, and shoulder arthroscopy with decompression; and adult reconstruction surgeons reduced the number of pills prescribed for total hip and knee arthroplasty. There was no change in the number of pills prescribed for lumbar spine fusion or implant removal. Satisfaction with the provider did not differ from before to after the summit; 75% of patients in the pre-summit group and 76% of patients in the post-summit group reported receiving excellent service (p = 0.62).
The creation of regional opioid-prescribing guidelines in a collaborative fashion was assessed at 1 participating institution and was found to be effective at reducing the number of opioid pills prescribed by the orthopaedic surgeons participating in the project without affecting patient satisfaction, but adherence to the guidelines varied by procedure.
特定机构、亚专业和手术所采用的旨在减少骨科阿片类药物处方的干预措施已取得成效。本研究的目的是检验制定常见骨科手术后阿片类药物处方实践的区域指南的有效性，确定指南的依从性是否因手术而异，并衡量指南对患者满意度的影响。所有目标均在1家参与机构进行评估。
2018年2月，代表纽约西部8家医疗机构的53名骨科外科医生参加了一次峰会，共同为70种常见骨科手术制定区域阿片类药物处方指南；这些指南随后以电子方式分发给纽约西部的所有骨科医生。我们回顾性研究了2017年10月（峰会召开前4个月）由1家大型医疗机构为成年患者实施骨科手术的阿片类药物处方实践（776例患者），以及2018年7月（峰会召开后5个月）的情况（653例患者）。使用t检验比较峰会前后术后开具的阿片类药物丸剂数量和患者满意度。
术后开具的阿片类药物丸剂的总体平均数量（及标准差）从峰会前的69.5±45.5丸降至峰会后的43.3±28.0丸（p<0.0001）。运动医学外科医生减少了前交叉韧带重建、关节镜下肩袖修复、半月板切除术的膝关节镜检查以及减压的肩关节镜检查所开具的丸剂数量；成人重建外科医生减少了全髋关节和膝关节置换术所开具的丸剂数量。腰椎融合术或植入物取出术所开具的丸剂数量没有变化。对医疗服务提供者的满意度在峰会前后没有差异；峰会前组75%的患者和峰会后组76%的患者报告得到了优质服务（p = 0.62）。
在1家参与机构评估了以协作方式制定区域阿片类药物处方指南的情况，发现该指南在不影响患者满意度的情况下，有效减少了参与项目的骨科外科医生开具的阿片类药物丸剂数量，但指南的依从性因手术而异。
