Opioid-Free Discharge is Not Associated With Increased Unplanned Healthcare Encounters After Ureteroscopy: Results From a Statewide Quality Improvement Collaborative.
Opioid-Free Discharge is Not Associated With Increased Unplanned Healthcare Encounters After Ureteroscopy: Results From a Statewide Quality Improvement Collaborative.
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DOI：
10.1016/j.urology.2021.07.037
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发表时间：
2021-12
期刊：
影响因子：
2.1
通讯作者：
Michigan Urological Surgery Improvement Collaborative
中科院分区：
文献类型：
--
作者：
Hawken SR;Hiller SC;Daignault-Newton S;Ghani KR;Hollingsworth JM;Conrado B;Maitland C;Wenzler DL;Ludlow JK;Ambani SN;Brummett CM;Dauw CA;Michigan Urological Surgery Improvement Collaborative
评估与输尿管镜检查后阿片类药物处方相关的患者因素，阿片类药物处方提供者水平的差异，以及非阿片类药物出院与急诊之间的关系。这是一项前瞻性队列研究，研究对象是2016年6月至2019年9月在密歇根州泌尿外科改善协作(MUSIC)减少肾结石(ROCKS)质量改进计划下接受初次输尿管镜检查的18岁及以上成年人。检查术后阿片类药物处方的趋势以及不同医生和外科医生之间的差异。多变量Logistic回归模型定义了接受阿片类药物处方的危险因素。在完全病例和倾向匹配的队列中，评估阿片类药物处方与手术后30天内急诊就诊之间的相关性，这些队列与除阿片类药物接受之外的所有测量特征匹配。13,143名患者在28个诊所的157名泌尿科医生的帮助下接受了输尿管镜检查。输尿管镜检后阿片类药物处方和急诊率下降(分别为86%至39%，P<；0.001；10%至6%，P<；0.001)。执业和外科医生层面的阿片类药物处方分别为8%~98%和0%~98%。与阿片类药物接收相关的患者相关因素包括男性、年轻和慢性疼痛病史。与阿片类药物使用相关的操作因素包括输尿管镜检前后、输尿管支架置入术和导尿鞘的使用。无阿片类药物出院与急诊率增加无关(OR0.77，95%CI0.62-0.95，p=0.014)。在输尿管镜检查后未开出阿片类药物的患者中，ED的使用率没有增加，这表明在这种情况下可能没有必要常规使用这些药物。
To evaluate patient factors associated with post-ureteroscopy opioid prescriptions, provider-level variation in opioid prescribing, and the relationship between opioid-free discharges and ED visits. This is a retrospective analysis of a prospective cohort study of adults age 18 years and older who underwent primary ureteroscopy for urinary stones from June 2016 to September 2019 within the Michigan Urological Surgery Improvement Collaborative (MUSIC) Reducing Operative Complications from Kidney Stones (ROCKS) quality improvement initiative. Postoperative opioid prescription trends and variation among practices and surgeons were examined. Multivariable logistic regression models defined risk factors for receipt of opioid prescriptions. The association among opioid prescriptions and postoperative ED visits within 30 days of surgery was assessed among complete case and propensity matched cohorts, matched on all measured characteristics other than opioid receipt. 13,143 patients underwent ureteroscopy with 157 urologists across 28 practices. Post-ureteroscopy opioid prescriptions and ED visits declined (86% to 39%, p<0.001; 10% to 6%, p<0.001, respectively). Practice and surgeon-level opioid prescribing varied from 8% to 98%, and 0% to 98%, respectively. Patient-related factors associated with opioid receipt included male, younger age, and history of chronic pain. Procedure-related factors associated with opioid receipt included pre-and post-ureteroscopy ureteral stenting and access sheath use. An opioid-free discharge was not associated with increased odds of an ED visit (OR 0.77, 95% CI 0.62-0.95, p=0.014). There was no increase in ED utilization among those not prescribed an opioid after ureteroscopy, suggesting their routine use may not be necessary in this setting.
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