Howard Ryan, Ryan Andrew, Hu Hsou Mei, Brown Craig S, Waljee Jennifer, Bicket Mark C, Englesbe Michael, Brummett Chad M
Department of Surgery.
Center for Healthcare Outcomes and Policy, Michigan Medicine.
Ann Surg. 2023 Aug 1;278(2):216-221. doi: 10.1097/SLA.0000000000005792. Epub 2023 Jan 2.
Evaluate the association of evidence-based opioid prescribing guidelines with new persistent opioid use after surgery.
Patients exposed to opioids after surgery are at risk of new persistent opioid use, which is associated with opioid use disorder and overdose. It is unknown whether evidence-based opioid prescribing guidelines mitigate this risk.
Using Medicare claims, we performed a difference-in-differences study of opioid-naive patients who underwent 1 of 6 common surgical procedures for which evidence-based postoperative opioid prescribing guidelines were released and disseminated through a statewide quality collaborative in Michigan in October 2017. The primary outcome was the incidence of new persistent opioid use, and the secondary outcome was total postoperative opioid prescription quantity in oral morphine equivalents (OME).
We identified 24,908 patients who underwent surgery in Michigan and 118,665 patients who underwent surgery outside of Michigan. Following the release of prescribing guidelines in Michigan, the adjusted incidence of new persistent opioid use decreased from 3.29% (95% CI 3.15-3.43%) to 2.51% (95% CI 2.35-2.67%) in Michigan, which was an additional 0.53 (95% CI 0.36-0.69) percentage point decrease compared with patients outside of Michigan. Simultaneously, adjusted opioid prescription quantity decreased from 199.5 (95% CI 198.3-200.6) mg OME to 88.6 (95% CI 78.7-98.5) mg OME in Michigan, which was an additional 55.7 (95% CI 46.5-65.4) mg OME decrease compared with patients outside of Michigan.
Evidence-based opioid prescribing guidelines were associated with a significant reduction in the incidence of new persistent opioid use and the quantity of opioids prescribed after surgery.
评估循证阿片类药物处方指南与术后新的持续性阿片类药物使用之间的关联。
术后接触阿片类药物的患者有新的持续性阿片类药物使用风险，这与阿片类药物使用障碍和过量用药有关。尚不清楚循证阿片类药物处方指南是否能降低这种风险。
利用医疗保险理赔数据，我们对未使用过阿片类药物且接受了6种常见外科手术之一的患者进行了一项双重差分研究，针对这些手术，循证术后阿片类药物处方指南于2017年10月在密歇根州通过全州质量协作发布并传播。主要结局是新的持续性阿片类药物使用的发生率，次要结局是以口服吗啡当量（OME）计算的术后阿片类药物总处方量。
我们确定了24,908名在密歇根州接受手术的患者和118,665名在密歇根州以外接受手术的患者。在密歇根州发布处方指南后，密歇根州新的持续性阿片类药物使用的校正发生率从3.29%（95%CI 3.15 - 3.43%）降至2.51%（95%CI 2.35 - 2.67%），与密歇根州以外的患者相比，额外降低了0.53（95%CI 0.36 - 0.69）个百分点。同时，密歇根州的阿片类药物校正处方量从199.5（95%CI 198.3 - 200.6）mg OME降至88.6（95%CI 78.7 - 98.5）mg OME，与密歇根州以外的患者相比，额外降低了55.7（95%CI 46.5 - 65.4）mg OME。
循证阿片类药物处方指南与术后新的持续性阿片类药物使用发生率和阿片类药物处方量的显著降低相关。
