From the Departments of Plastic and Reconstructive Surgery and Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center; and the National Clinician Scholars Program at the Institute for Healthcare Policy and Innovation, University of Michigan.
Plast Reconstr Surg. 2022 Jul 1;150(1):213-221. doi: 10.1097/PRS.0000000000009239. Epub 2022 May 20.
Overprescription of opioids for acute postoperative pain, plastic surgery procedures included, is contributing to the pervasive opioid epidemic in the United States. This study examines the effect of a statewide legislation limiting postoperative opioids on opioid prescription behavior among providers following outpatient plastic surgery procedures at a high-volume academic center.
Retrospective review of all outpatient surgical encounters between June 1, 2016, and November 30, 2018, was performed. Encounters were grouped into two cohorts: prepolicy and postpolicy. Primary outcomes included total oral morphine equivalents prescribed on the day of surgery and proportion of patients prescribed greater than 210 oral morphine equivalents. Secondary outcomes included proportion of patients requiring an opioid refill within 30 days following surgery, and number of refills required.
The mean oral morphine equivalents prescribed on the day of surgery was reduced from 271.8 to 150.37 oral morphine equivalents ( p < 0.001) following implementation of the legislation, with an associated decrease in the standard deviation of oral morphine equivalents prescribed from 225.35 to 196.71 ( p < 0.001), suggesting a decrease in the variability of prescriber practices. Time series analysis demonstrated the decrease in oral morphine equivalents remained significant when accounting for baseline level of change in opioid prescription patterns.
This study provides evidence that legislation at the state level restricting postoperative opioid prescriptions is associated with a decrease in opioid prescriptions without an increase in the need for refills in the acute postoperative setting following outpatient plastic surgery procedures.
在美国，阿片类药物被过度开用于急性术后疼痛，包括整形手术，这导致了阿片类药物泛滥的普遍现象。本研究考察了一项限制术后阿片类药物处方的州级立法对一家高容量学术中心进行门诊整形手术后提供者开处阿片类药物行为的影响。
对 2016 年 6 月 1 日至 2018 年 11 月 30 日期间所有门诊手术的手术记录进行了回顾性分析。将手术记录分为两组：政策前和政策后。主要结局指标包括手术当天开处的口服吗啡等效物总量和处方超过 210 口服吗啡等效物的患者比例。次要结局指标包括术后 30 天内需要阿片类药物续方的患者比例和需要续方的次数。
在实施该法规后，手术当天开处的口服吗啡等效物从 271.8 降至 150.37 吗啡等效物（p < 0.001），同时开处的口服吗啡等效物标准差从 225.35 降至 196.71（p < 0.001），表明提供者实践的变异性降低。时间序列分析表明，在考虑到阿片类药物处方模式基线变化水平的情况下，口服吗啡等效物的减少仍然具有统计学意义。
本研究提供了证据表明，限制术后阿片类药物处方的州级立法与减少阿片类药物处方有关，而在门诊整形手术后的急性术后环境中，并不需要增加续方的需求。
