Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada.
Institute of Health Policy Management and Evaluation, Toronto, ON, Canada.
Can J Anaesth. 2022 Aug;69(8):974-985. doi: 10.1007/s12630-022-02266-5. Epub 2022 May 10.
Many hospital and provincial-level recommendations now advise a tailored approach to postoperative opioid prescribing; recent trends in postoperative prescribing at the population level have not been well described.
This population-based cohort study included opioid-naïve patients ≥ 18 yr of age who underwent one of 16 surgical procedures with varying anticipated postoperative pain between July 2013 and March 2020. We evaluated the rate of filled opioid prescriptions within seven days postoperatively, the total morphine milligram equivalent (MME) dose, duration, and type of the first opioid prescription. We then compared the MMEs in initial opioid prescriptions with available procedure-specific recommendations.
The sample included 900,989 opioid-naïve patients (mean [standard deviation (SD)] age of 50 [17] 31 yr; 66% women). The percentage of patients filling an opioid prescription within 7 days postoperatively increased from 65% in 2013 to 69% in 2016, and returned to the baseline (65%) in 2019. The mean (SD) MMEs dispensed increased until 2015/2016 and then declined (226 [176] MMEs in 2013, 240 [202] MMEs in 2016, and 175 [175] MMEs in 2019). The most frequently prescribed opioid in 2013 was oxycodone compared with hydromorphone in 2019. Among patients who filled an opioid prescription in 2013, 67% were prescribed an opioid dose higher than those in one set of available prescribing recommendations, while in 2019, 41% were prescribed doses above those stated in recommendations.
While the proportion of patients filling an opioid prescription postoperatively remained s during the study period, MMEs decreased after 2016. Opioid prescribing remained significantly higher than available prescribing recommendations, particularly among low pain procedures. These findings highlight the need to identify strategies that improve adherence to surgery-specific prescribing guidelines in North America.
许多医院和省级建议现在建议采用个体化方法开具术后阿片类药物处方；但人群水平术后处方的近期趋势尚未得到很好描述。
本基于人群的队列研究纳入了 2013 年 7 月至 2020 年 3 月期间行 16 种不同预计术后疼痛手术的、年龄≥18 岁的阿片类药物初治患者。我们评估了术后 7 天内填写的阿片类药物处方率、总吗啡毫克当量（MME）剂量、持续时间和首次阿片类药物处方类型。然后，我们将初始阿片类药物处方的 MME 与可用的特定手术推荐进行比较。
该样本包括 900989 名阿片类药物初治患者（平均[标准差]年龄 50[17]岁，31 岁；66%为女性）。术后 7 天内填写阿片类药物处方的患者比例从 2013 年的 65%增加到 2016 年的 69%，然后在 2019 年恢复到基线（65%）。开出的 MME 均值（标准差）在 2015/2016 年之前增加，然后下降（2013 年 226[176]MME，2016 年 240[202]MME，2019 年 175[175]MME）。2013 年最常开的阿片类药物是羟考酮，而 2019 年则是氢吗啡酮。在 2013 年填写阿片类药物处方的患者中，67%的患者开的阿片类药物剂量高于一组可用的处方推荐，而在 2019 年，41%的患者开的剂量高于推荐剂量。
虽然研究期间术后填写阿片类药物处方的患者比例保持稳定，但 MME 在 2016 年后下降。阿片类药物的开具仍然明显高于可用的处方推荐，尤其是在低疼痛手术中。这些发现强调了需要确定策略，以提高北美手术特定处方指南的依从性。
