门诊骨科手术后阿片类药物分布及慢性阿片类药物使用者的变化：一项干预前后研究
Changes in opioid distribution and chronic opioid users following outpatient orthopedic surgery: a pre-post intervention study.
作者信息
Hemstock Riley, McRae Sheila, Laxdal Ian, Mutter Thomas, Friesen Kevin, Prior Heather J, Old Jason, Stranges Gregory, Lemmex Devin, Dubberley James, Marsh Jonathan, Longstaffe Robert, MacDonald Peter, Woodmass Jarret
机构信息
From the Department of Surgery, Orthopaedic Section, University of Manitoba, Winnipeg, Man. (Hemstock, McRae, Laxdal, Old, Stranges, Lemmex, Dubberley, Marsh, Longstaffe, MacDonald, Woodmass); the Pan Am Clinic Foundation, Winnipeg, Man. (McRae); the Pan Am Clinic, Winnipeg, Man. (Old, Stranges, Lemmex, Dubberley, Marsh, Longstaffe, MacDonald, Woodmass); the Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, Man. (Mutter); the Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Man. (Friesen, Prior).
From the Department of Surgery, Orthopaedic Section, University of Manitoba, Winnipeg, Man. (Hemstock, McRae, Laxdal, Old, Stranges, Lemmex, Dubberley, Marsh, Longstaffe, MacDonald, Woodmass); the Pan Am Clinic Foundation, Winnipeg, Man. (McRae); the Pan Am Clinic, Winnipeg, Man. (Old, Stranges, Lemmex, Dubberley, Marsh, Longstaffe, MacDonald, Woodmass); the Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, Man. (Mutter); the Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Man. (Friesen, Prior)
出版信息
Can J Surg. 2025 Jun 18;68(3):E265-E270. doi: 10.1503/cjs.000325. Print 2025 May-Jun.
BACKGROUND
Outpatient overprescribing of opioids in the postoperative period contributes to the opioid epidemic. Given that patient education and evidence-informed prescription protocols have reduced postoperative opioid use in small, randomized trials, we sought to evaluate the effectiveness of a multimodal opioid reduction protocol, implemented institution-wide at an outpatient Canadian orthopedic surgery centre.
METHODS
In this pre-post intervention study, we used deidentified health administrative data from a provincial data repository to identify all opioid-naive patients who underwent outpatient shoulder or knee surgery at a single institution between 2013 and 2022. An opioid restriction protocol was implemented in 2019, including an educational pamphlet, perioperative verbal education, and a standardized postoperative analgesic prescription. Outcomes analyzed included dispensed morphine milligram equivalents (MME) per patient within 180 days of surgery and chronic opioid use, defined as opioids dispensed 180-270 days after surgery. Prescriptions dispensed from any provider were included.
RESULTS
We included 8244 patients preintervention and 2205 patients postintervention in the analyses. The average MME dispensed per patient decreased by 18% (57.8 MME, 95% confidence interval 45.0-70.6). The proportion of patients who filled opioid prescriptions beyond 180 days after surgery decreased from 4.8% to 2.6% ( < 0.001). These findings remained consistent after adjustment for age, sex, socioeconomic status, mental health, and medical comorbidity in multivariable regression analyses.
CONCLUSION
The volume of opioids dispensed and the number of chronic opioid users were significantly reduced among patients who underwent outpatient orthopedic surgery after the institution-wide implementation of a multimodal postoperative opioid reduction protocol.
背景
术后门诊阿片类药物的过度处方是导致阿片类药物流行的原因之一。鉴于在小型随机试验中，患者教育和基于证据的处方方案已减少了术后阿片类药物的使用，我们试图评估在加拿大一家门诊骨科手术中心全机构实施的多模式阿片类药物减量方案的有效性。
方法
在这项干预前后的研究中，我们使用了省级数据存储库中去识别化的卫生行政数据，以确定2013年至2022年间在单一机构接受门诊肩部或膝部手术的所有未使用过阿片类药物的患者。2019年实施了阿片类药物限制方案，包括一份教育手册、围手术期口头教育和标准化的术后镇痛处方。分析的结果包括术后180天内每位患者的吗啡毫克当量（MME）配药量以及慢性阿片类药物使用情况，慢性阿片类药物使用定义为术后180 - 270天的阿片类药物配药量。纳入了任何提供者开具的处方。
结果
分析中我们纳入了干预前的8244名患者和干预后的2205名患者。每位患者的平均MME配药量下降了18%（57.8 MME，95%置信区间45.0 - 70.6）。术后180天以上开具阿片类药物处方的患者比例从4.8%降至2.6%（<0.001）。在多变量回归分析中对年龄、性别、社会经济地位、心理健康和合并症进行调整后这些结果仍然一致。
结论
在全机构实施多模式术后阿片类药物减量方案后，接受门诊骨科手术的患者中阿片类药物的配药量和慢性阿片类药物使用者数量显著减少。
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