Langnas Erica, Rodriguez-Monguio Rosa, Luo Yanting, Croci Rhiannon, Dudley R Adams, Chen Catherine L
Department of Anesthesia and Perioperative Care, University of California, San Francisco, 513 Parnassus Ave, S455, San Francisco, CA, 94143, USA.
Department of Clinical Pharmacy, University of California, San Francisco, San Francisco, USA.
Perioper Med (Lond). 2021 Dec 15;10(1):60. doi: 10.1186/s13741-021-00230-3.
Opioids and multimodal analgesia are widely administered to manage postoperative pain. However, little is known on how improvements in inpatient pain control are correlated with high-risk (> 90 daily OME) discharge opioid prescriptions for opioid naïve surgical patients.
We conducted a retrospective observational study of adult opioid-naïve patients undergoing surgery from June 2012 through December 2018 at a large academic medical center. We used multivariate logistic regression to assess whether multimodal analgesic drugs consumed in the 24 h prior to discharge was associated with a reduction in high-risk opioid discharge prescriptions. We identified other risk factors for receiving a high-risk discharge opioid prescription.
Among the 32,511 patients, 83% of patients were discharged with an opioid prescription. In 2013, 34.1% of patients with a discharge opioid prescription received a high-risk prescription and this declined to 17.7% by 2018. Use of multimodal analgesic agents during the final 24 h of hospitalization increased each year, with over 80% receiving at least one multimodal analgesic agent by 2018. The median OME consumed in the 24 h prior to discharge peaked in 2013 at 31 and steadily decreased to 19.8 by 2018. There was a significant association between the use of acetaminophen in the 24 h prior to discharge and a high-risk prescription at discharge (p < 0.01). OMEs consumed in the 24 h prior to discharge was a significant predictor of receiving a high-risk discharge prescription, even at low doses. Other factors associated with receipt of a high-risk discharge opioid prescription included male gender, race, history of anxiety disorder, and discharge service.
Use of multimodal analgesia regimens in hospitalized surgical patients in the 24 h prior to hospital discharge increased between 2012 and 2018. Simultaneously, opioid use prior to hospital discharge decreased. Despite these gains, approximately one in five discharge prescriptions was high-risk (> 90 daily OME). In addition, we found that prescribing of discharge opioids above inpatient opioid requirements remains common in opioid naive surgical patients.
Providers should account for pre-discharge opioid consumption and use of multimodal analgesia when considering the total and daily OME's that may be appropriate for an individual surgical patient on the discharge opioid prescription.
阿片类药物和多模式镇痛被广泛用于控制术后疼痛。然而，对于阿片类药物初治手术患者住院疼痛控制的改善与高风险（每日口服吗啡当量>90）出院阿片类药物处方之间的关联，人们了解甚少。
我们对2012年6月至2018年12月在一家大型学术医疗中心接受手术的成年阿片类药物初治患者进行了一项回顾性观察研究。我们使用多因素逻辑回归来评估出院前24小时内使用的多模式镇痛药物是否与高风险阿片类药物出院处方的减少有关。我们确定了接受高风险出院阿片类药物处方的其他风险因素。
在32511名患者中，83%的患者出院时开具了阿片类药物处方。2013年，34.1%的出院阿片类药物处方患者接受了高风险处方，到2018年这一比例降至17.7%。住院最后24小时内多模式镇痛药物的使用逐年增加，到2018年超过80%的患者接受了至少一种多模式镇痛药物。出院前24小时内口服吗啡当量的中位数在2013年达到峰值31，并在2018年稳步降至19.8。出院前24小时内使用对乙酰氨基酚与出院时的高风险处方之间存在显著关联（p<0.01）。出院前24小时内口服吗啡当量是接受高风险出院处方的重要预测因素，即使是低剂量时也是如此。与接受高风险出院阿片类药物处方相关的其他因素包括男性、种族、焦虑症病史和出院科室。
2012年至2018年期间，住院手术患者出院前24小时内多模式镇痛方案的使用有所增加。同时，出院前阿片类药物的使用减少。尽管有这些进展，但约五分之一的出院处方是高风险的（每日口服吗啡当量>90）。此外，我们发现，在阿片类药物初治手术患者中，出院阿片类药物的处方量超过住院期间阿片类药物需求量的情况仍然很常见。
在考虑出院阿片类药物处方中适合个体手术患者的每日口服吗啡当量总量时，医疗服务提供者应考虑出院前阿片类药物的使用情况和多模式镇痛的使用情况。
