Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery Surgical Outcomes Program, Mayo Clinic, Rochester, Minnesota, USA.
Neurosurgery. 2021 Aug 16;89(3):460-470. doi: 10.1093/neuros/nyab196.
BACKGROUND: With a dramatic rise in prescription opioid use, it is imperative to review postsurgical prescribing patterns given their contributions to the opioid epidemic. OBJECTIVE: To evaluate the impact of departmental postoperative prescribing guidelines on opioid prescriptions following elective spine surgery. METHODS: Patients undergoing elective cervical or lumbar spine surgery between 2017 and 2018 were identified. Procedure-specific opioid prescribing guidelines to limit postoperative prescribing following neurosurgical procedures were developed in 2017 and implemented in January 2018. Preguideline data were available from July to December 2017, and postguideline data from July to December 2018. Discharge prescriptions in morphine milliequivalents (MMEs), the proportion of patients (i) discharged with an opioid prescription, (ii) needing refills within 30 d, (iii) with guideline compliant prescriptions were compared in the 2 groups. Multivariable (MV) analyses were performed to assess the impact of guideline implementation on refill prescriptions within 30 d. RESULTS: A total of 1193 patients were identified (cervical: 308; lumbar: 885) with 569 (47.7%) patients from the preguideline period. Following guideline implementation, fewer patients were discharged with a postoperative opioid prescription (92.5% vs 81.7%, P < .001) and median postoperative opioid prescription decreased significantly (300 MMEs vs 225 MMEs, P < .001). The 30-d refill prescription rate was not significantly different between preguideline and postguideline cohorts (pre: 24.4% vs post: 20.2%, P = .079). MV analyses did not demonstrate any impact of guideline implementation on need for 30-d refill prescriptions for both cervical (odds ratio [OR] = 0.68, confidence interval [CI] = 0.37-1.26, P = .22) and lumbar cohorts (OR = 0.95, CI = 0.66-1.36, P = .78). CONCLUSION: Provider-aimed interventions such as implementation of procedure-specific prescribing guidelines can significantly reduce postoperative opioid prescriptions following spine surgery without increasing the need for refill prescriptions for pain control.
背景：随着处方类阿片类药物的使用急剧增加，审查术后处方模式势在必行，因为这些模式导致了阿片类药物泛滥。
目的：评估科室术后处方指南对择期脊柱手术后阿片类药物处方的影响。
方法：确定 2017 年至 2018 年期间接受择期颈椎或腰椎脊柱手术的患者。2017 年制定了特定于手术程序的阿片类药物处方指南，以限制神经外科手术后的术后处方。术前数据可追溯至 2017 年 7 月至 12 月，术后数据可追溯至 2018 年 7 月至 12 月。比较两组患者出院时吗啡毫当量（MME）的处方量、（i）出院时开具阿片类药物处方的患者比例、（ii）30 天内需要处方续药的患者比例、（iii）符合指南规定的处方比例。采用多变量（MV）分析评估指南实施对 30 天内续药处方的影响。
结果：共确定了 1193 例患者（颈椎：308 例；腰椎：885 例），其中 569 例（47.7%）来自术前阶段。在指南实施后，出院时开具阿片类药物处方的患者比例明显减少（92.5% vs 81.7%，P<0.001），术后阿片类药物处方中位数明显降低（300 MMEs vs 225 MMEs，P<0.001）。术前和术后队列的 30 天内续药处方率无显著差异（术前：24.4% vs 术后：20.2%，P=0.079）。MV 分析未显示指南实施对颈椎（比值比[OR] = 0.68，置信区间[CI] = 0.37-1.26，P=0.22）和腰椎队列（OR = 0.95，CI = 0.66-1.36，P=0.78）患者 30 天内续药需求的任何影响。
结论：针对提供者的干预措施，如实施特定于手术程序的处方指南，可以显著减少脊柱手术后的术后阿片类药物处方，而不会增加疼痛控制的续药需求。
J Pediatr Orthop. 2022-1-1
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