Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada.
Health Sector Information, Analysis and Reporting Division, British Columbia Ministry of Health, Victoria, BC, Canada.
Can J Anaesth. 2022 Aug;69(8):986-996. doi: 10.1007/s12630-022-02272-7. Epub 2022 Jun 29.
Postdischarge opioid prescriptions are reportedly much higher in Canada than in other countries. To assess potentially contributing factors, we examined trends after abdominal and orthopedic surgeries in British Columbia (BC).
Using the BC Ministry of Health's databases on physician billings, hospital discharge abstracts, and medication dispensations in community pharmacies for the period 2003-2016, we assembled a cohort of 263,056 patients who received laparoscopic appendectomy (LA, 11%), laparoscopic cholecystectomy (LC, 30%), open inguinal or femoral hernia repair (IHR, 20%), total hip arthroplasty (THA, 18%), or total knee arthroplasty (TKA, 22%). Adjusting for covariates using generalized linear modeling, we measured trends in percentages of patients dispensed opioids postdischarge (opioid rate) within 30 days after surgery, by surgery type, opioid type, prior use, surgeon, and trends in morphine milligram equivalents of first dispensations (MME) with 95% confidence intervals (CI).
Opioid dispensation rates rose steadily. Mean annual increases were 1.7% in LA; 1.3% in LC; 0.8% in IHR; 0.9% in THA; and 0.8% in TKA. By 2016, rates were 69% in LA; 76% in LC; 81% in IHR; 88% in THA; and 94% in TKA. Codeine dispensations fell 2.4% (abdominal) and 3.1% (orthopedic) per year while tramadol dispensations increased 3.6% (abdominal) and 1.7% (orthopedic). Hydromorphone dispensations increased 2.9% per year (orthopedic); oxycodone was level at 22% between 2007 and 2014, but then fell. The mean MME rose 8 mg⋅yr (95% CI, 7 to 9) (abdominal) and 61 mg⋅yr (95% CI, 58 to 64) (orthopedic). Variation in rates was greater among abdominal than orthopedic surgeons.
Rising opioid dispensation rates, together with shifts to prescribing higher MME opioids, doubled MME per patient in first dispensations postdischarge after abdominal or orthopedic surgery from 2003 to 2016 in BC.
据报道，加拿大的出院后阿片类药物处方量远远高于其他国家。为了评估可能的促成因素，我们检查了不列颠哥伦比亚省（BC）腹部和骨科手术后的趋势。
使用 BC 卫生部关于医生账单、医院出院摘要和社区药店药物配药的数据库，我们收集了 2003 年至 2016 年期间接受腹腔镜阑尾切除术（LA，11%）、腹腔镜胆囊切除术（LC，30%）、开放式腹股沟或股疝修补术（IHR，20%）、全髋关节置换术（THA，18%）或全膝关节置换术（TKA，22%）的 263,056 名患者的队列。使用广义线性模型调整协变量，我们测量了手术后 30 天内患者出院后开具阿片类药物的百分比（阿片类药物率）的趋势，按手术类型、阿片类药物类型、既往使用、外科医生和首次配药的吗啡毫克当量（MME）的趋势进行测量，置信区间（CI）为 95%。
阿片类药物配药率稳步上升。LA 中平均年增长率为 1.7%；LC 中为 1.3%；IHR 中为 0.8%；THA 中为 0.9%；TKA 中为 0.8%。到 2016 年，LA 的比例为 69%；LC 为 76%；IHR 为 81%；THA 为 88%；TKA 为 94%。每年 codeine 的配药量下降 2.4%（腹部）和 3.1%（骨科），而 tramadol 的配药量分别增加 3.6%（腹部）和 1.7%（骨科）。羟吗啡酮的配药量每年增加 2.9%（骨科）；oxycodone 在 2007 年至 2014 年间保持在 22%不变，但随后下降。腹部手术和骨科手术的平均 MME 分别增加 8mg·yr（95%CI，7-9）和 61mg·yr（95%CI，58-64）。腹部外科医生之间的配药率差异大于骨科医生。
从 2003 年到 2016 年，BC 腹部或骨科手术后出院后阿片类药物的开具率上升，加上开更高 MME 阿片类药物的趋势，使腹部或骨科手术后首次配药的每位患者的 MME 增加了一倍。
