在线处方药物监测对选择性单节段腰椎融合术后阿片类药物处方习惯的影响。

The Effect of Online Prescription Drug Monitoring on Opioid Prescription Habits After Elective Single-level Lumbar Fusion.

机构信息

From the Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA.

出版信息

J Am Acad Orthop Surg. 2022 Nov 1;30(21):e1411-e1418. doi: 10.5435/JAAOS-D-22-00433. Epub 2022 Aug 9.

DOI:10.5435/JAAOS-D-22-00433

PMID:35947832

Abstract

INTRODUCTION

The United States opioid epidemic is a well-documented crisis stemming from increased prescriptions of narcotics. Online prescription drug monitoring programs (PDMPs) are a potential resource to mitigate narcotic misuse by tracking controlled substance prescriptions. Therefore, the purpose of this study was to evaluate opioid prescription trends after implementation of an online PDMP in patients who underwent single-level lumbar fusion.

METHODS

Patients who underwent a single-level lumbar fusion between August 27, 2017, and August 31, 2020, were identified and placed categorically into one of two cohorts: an "early adoption" cohort, September 1, 2017, to August 31, 2018, and a "late adoption" cohort, September 1, 2019, to August 31, 2020. This allowed for a 1-year washout period after Pennsylvania PDMP implementation on August 26, 2016. Opioid use data were obtained by searching for each patient in the state government's online PDMP and recording data from the year before and the year after the patient's procedure.

RESULTS

No significant difference was observed in preoperative opioid prescriptions between the early and late adoption cohorts. The late adoption group independently predicted decreased postoperative opioid prescriptions (β, 0.78; 95% confidence interval [CI], 0.65 to 0.93; P = 0.007), opioid prescribers (β, 0.81; 95% CI, 0.72 to 0.90; P < 0.001), pharmacies used (β, 0.90; 95% CI, 0.83 to 0.97; P = 0.006), opioid pills (β, 0.61; 95% CI, 0.50 to 0.74; P < 0.001), days of opioid prescription (β, 0.57; 95% CI, 0.45 to 0.72; P < 0.001), and morphine milligram equivalents prescribed (β, 0.53; 95% CI, 0.43 to 0.66; P < 0.001).

CONCLUSIONS

PDMP implementation was associated with decreased postoperative opioid prescription patterns but not preoperative opioid prescribing behaviors.

LEVELS OF EVIDENCE

摘要

简介

美国阿片类药物泛滥是一场有充分记录的危机，其根源是麻醉类药物处方的增加。在线处方药物监测计划（PDMP）是一种通过跟踪管制药物处方来减轻麻醉类药物滥用的潜在资源。因此，本研究的目的是评估在宾夕法尼亚州 PDMP 于 2016 年 8 月 26 日实施后，对接受单节段腰椎融合术的患者实施在线 PDMP 后，阿片类药物处方的趋势。

方法

确定了 2017 年 8 月 27 日至 2020 年 8 月 31 日期间接受单节段腰椎融合术的患者，并将他们分为两个队列中的一个：“早期采用”队列（2017 年 9 月 1 日至 2018 年 8 月 31 日）和“晚期采用”队列（2019 年 9 月 1 日至 2020 年 8 月 31 日）。这为宾夕法尼亚州 PDMP 于 2016 年 8 月 26 日实施后的 1 年洗脱期提供了便利。通过在州政府的在线 PDMP 中搜索每位患者，获取患者术前和术后一年的阿片类药物使用数据，并记录数据。

结果

早期和晚期采用队列之间，术前阿片类药物处方没有显著差异。晚期采用组独立预测术后阿片类药物处方减少（β，0.78；95%置信区间 [CI]，0.65 至 0.93；P = 0.007），阿片类药物开处方者（β，0.81；95% CI，0.72 至 0.90；P < 0.001），使用的药房（β，0.90；95% CI，0.83 至 0.97；P = 0.006），阿片类药物丸（β，0.61；95% CI，0.50 至 0.74；P < 0.001），阿片类药物处方天数（β，0.57；95% CI，0.45 至 0.72；P < 0.001），以及规定的吗啡毫克当量（β，0.53；95% CI，0.43 至 0.66；P < 0.001）。