Hussaini S Hanif, Wang Kevin Y, Luo T David, Scott Aaron T
Department of Orthopaedic Surgery, Wake Forest Baptist Medical Center, NC, USA.
Foot Ankle Orthop. 2019 Nov 28;4(4):2473011419889023. doi: 10.1177/2473011419889023. eCollection 2019 Oct.
In North Carolina, the Strengthen Opioid Misuse Prevention Act of 2017 (STOP Act) went into effect on January 1, 2018, intending to increase oversight over opioid prescriptions. This study compares postoperative narcotic prescription practices following operative fixation of ankle fractures before and after the STOP Act.
This study was a retrospective review of patients 18 years and older who underwent operative fixation of ankle fractures between January 1 and June 30, 2017 (before STOP Act), and between January 1 and June 30, 2018 (after STOP Act). Variables of interest included demographics, amount of opioids prescribed postoperatively, number of prescription refills, and number of pain-related calls or visits to the emergency department (ED) or clinic after surgery. This study assessed 71 patients in the Pre group and 47 patients in the Post group.
There was a statistically significant decrease in the average number of postoperative narcotic pills prescribed after the STOP Act (52.7 vs 76.2, < .001). There was also a statistically significant decrease in the average number of prescription refills (0.6 vs 1.0, = .037). There were no significant changes in pain-related clinic calls (35.2% Pre vs 34.0% Post, = .896), pain-related clinic visits ahead of schedule (4.2% Pre vs 6.4% Post, = .681), or pain-related ED visits (2.8% Pre vs 10.6% Post, = .113).
In the postoperative period after operative fixation of ankle fractures, the volume of narcotic prescriptions decreased after the new legislation, without an associated strain on medical resources.
Level III, therapeutic, comparative study.
在北卡罗来纳州，2017年的《加强阿片类药物滥用预防法案》（STOP法案）于2018年1月1日生效，旨在加强对阿片类药物处方的监管。本研究比较了STOP法案实施前后踝关节骨折手术固定术后的麻醉处方做法。
本研究是一项回顾性研究，纳入了2017年1月1日至6月30日（STOP法案实施前）以及2018年1月1日至6月30日（STOP法案实施后）期间接受踝关节骨折手术固定的18岁及以上患者。感兴趣的变量包括人口统计学特征、术后开具的阿片类药物数量、处方 refill次数以及术后因疼痛致电或前往急诊科（ED）或诊所就诊的次数。本研究评估了术前组71例患者和术后组47例患者。
STOP法案实施后，术后开具的麻醉药平均数量有统计学显著下降（52.7对76.2，<0.001）。处方 refill的平均数量也有统计学显著下降（0.6对1.0，=0.037）。与疼痛相关的诊所致电（术前35.2%对术后34.0%，=0.896）、提前的与疼痛相关的诊所就诊（术前4.2%对术后6.4%，=0.681）或与疼痛相关的ED就诊（术前2.8%对术后10.6%，=0.113）均无显著变化。
在踝关节骨折手术固定后的术后期间，新立法后麻醉处方量减少，且未对医疗资源造成相关压力。
三级，治疗性、比较研究。
