拔牙后影响阿片类药物处方的因素。

Factors influencing opioid prescribing after tooth extraction.

出版信息

J Am Dent Assoc. 2022 Sep;153(9):868-877. doi: 10.1016/j.adaj.2022.05.001. Epub 2022 Jun 9.

DOI:10.1016/j.adaj.2022.05.001

Abstract

BACKGROUND

Tooth extractions account for most opioid prescriptions from dentists, but specific characteristics that influence likelihood are less established. Improving understanding can facilitate development of tailored interventions to reduce unnecessary opioid prescribing.

METHODS

The authors performed a retrospective review of patients 12 years and older undergoing tooth extraction at the College of Dentistry at the University of Kentucky from 2013 through 2020. The primary end point was issuance of an opioid prescription related to the encounter.

RESULTS

In 44,387 eligible records analyzed, 10,628 (23.9%) patients received an opioid prescription. Results of multivariable logistic regression found that the factors associated with an opioid prescription included receipt of a nonopioid analgesic prescription (adjusted odds ratio [aOR], 11.36; 95% CI, 10.37 to 12.44), receipt of an antibiotic prescription (aOR, 8.29; 95% CI, 7.57 to 9.08), procedural sedation (aOR, 2.11; 95% CI, 1.93 to 2.31), surgical extraction (aOR, 1.96; 95% CI, 1.84 to 2.10), and third molar extractions (1 tooth: aOR, 1.14; 95% CI 1.04 to 1.25; 2 teeth: aOR, 2.09; 95% CI, 2.87 to 2.34; 3 teeth: aOR, 2.73; 95% CI, 2.36 to 3.15; 4 teeth: aOR, 3.45; 95% CI, 3.10 to 3.83). Factors that decreased risk included having an appointment in 2018 or later (aOR, 0.31; 95% CI, 0.29 to 0.33), in a student (aOR, 0.57; 95% CI, 0.51 to 0.65) or resident (aOR, 0.33; 95% CI, 0.31 to 0.36) clinic, and on any day other than Friday (Monday: aOR, 0.83; 95% CI, 0.76 to 0.91; Tuesday: aOR, 0.90; 95% CI, 0.83 to 0.99; Wednesday: aOR, 0.89; 95% CI, 0.81 to 0.97; Thursday: aOR, 0.88; 95% CI 0.81 to 0.97).

CONCLUSIONS

Opioid prescriptions after tooth extraction were common in patients undergoing more extensive procedures. Provider perceptions, habits, and several clinical factors appeared to influence prescribing patterns.

PRACTICAL IMPLICATIONS

The decision to prescribe an opioid appears to be associated with habits and factors perceived to modulate postoperative pain, which may serve as targets for opioid reduction strategies.

摘要

背景

拔牙是牙医开出的大多数阿片类药物处方的原因，但影响可能性的具体特征尚未确定。更好地了解这些特征可以促进开发有针对性的干预措施，以减少不必要的阿片类药物处方。

方法

作者对肯塔基大学牙科学院 2013 年至 2020 年间 12 岁及以上接受拔牙的患者进行了回顾性分析。主要终点是与就诊相关的阿片类药物处方的开具情况。

结果

在分析的 44387 份合格记录中，10628 份（23.9%）患者收到了阿片类药物处方。多变量逻辑回归结果发现，与阿片类药物处方相关的因素包括接受非阿片类镇痛药处方（调整后优势比[aOR]，11.36；95%CI，10.37 至 12.44）、接受抗生素处方（aOR，8.29；95%CI，7.57 至 9.08）、程序性镇静（aOR，2.11；95%CI，1.93 至 2.31）、手术拔牙（aOR，1.96；95%CI，1.84 至 2.10）和第三磨牙拔牙（1 颗牙：aOR，1.14；95%CI，1.04 至 1.25；2 颗牙：aOR，2.09；95%CI，2.87 至 2.34；3 颗牙：aOR，2.73；95%CI，2.36 至 3.15；4 颗牙：aOR，3.45；95%CI，3.10 至 3.83）。降低风险的因素包括预约在 2018 年或以后（aOR，0.31；95%CI，0.29 至 0.33）、在学生（aOR，0.57；95%CI，0.51 至 0.65）或住院医师（aOR，0.33；95%CI，0.31 至 0.36）诊所就诊，以及周五以外的任何一天（周一：aOR，0.83；95%CI，0.76 至 0.91；周二：aOR，0.90；95%CI，0.83 至 0.99；周三：aOR，0.89；95%CI，0.81 至 0.97；周四：aOR，0.88；95%CI 0.81 至 0.97）。