Opioid Prescribing After Surgery in the United States, Canada, and Sweden
Opioid Prescribing After Surgery in the United States, Canada, and Sweden
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DOI：
10.1001/jamanetworkopen.2019.10734
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发表时间：
2019-09-01
影响因子：
13.8
通讯作者：
Wunch, Hannah
中科院分区：
文献类型：
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作者：
Ladha, Karim S.;Neuman, Mark D.;Wunch, Hannah
小规模研究和轶事证据表明，国际上手术后阿片类药物的使用存在显著差异;然而，这还没有在不同国家接受类似手术的人群中进行系统的评估。目的：确定美国、加拿大和瑞典手术后阿片类药物的使用频率、数量和类型是否存在差异。和参与者这项队列研究包括16至64岁的既往未接受过阿片类药物处方的患者，他们接受了4次低风险外科手术（即腹腔镜胆囊切除术、腹腔镜阑尾切除术、关节镜膝关节切除术和乳房切除术），2013年7月至2016年3月在加拿大，2013年1月至2014年12月在瑞典。数据分析于2018年7月至2018年10月在所有3个国家进行。主要结局和指标主要结局为出院后7天内填写的术后阿片类药物处方;服用处方的患者百分比，总吗啡毫克当量（MME）剂量，结果研究样本包括美国129379例患者，加拿大84653例患者和瑞典9802例患者。总体而言，52427例患者在美国，40.5%为男性，平均（SD）年龄为45.1岁（12.7）岁;在加拿大，25074例患者（29.6%）为男性，平均（SD）年龄为43.5（13.0）岁;在瑞典，3314例（33.8%）为男性，平均（SD）年龄为42.5（13.0）岁。瑞典患者出院后7天内服用阿片类药物的比例低于美国和加拿大患者（瑞典，1086 [11.1%];美国，98 594 [76.2%];加拿大，66 544 [78.6%]; P
IMPORTANCE Small studies and anecdotal evidence suggest marked differences in the use of opioids after surgery internationally; however, this has not been evaluated systematically across populations receiving similar procedures in different countries.OBJECTIVE To determine whether there are differences in the frequency, amount, and type of opioids dispensed after surgery among the United States, Canada, and Sweden.DESIGN, SETTING, AND PARTICIPANTS This cohort study included patients without previous opioid prescriptions aged 16 to 64 years who underwent 4 low-risk surgical procedures (ie, laparoscopic cholecystectomy, laparoscopic appendectomy, arthroscopic knee meniscectomy, and breast excision) between January 2013 and December 2015 in the United States, between July 2013 and March 2016 in Canada, and between January 2013 and December 2014 in Sweden. Data analysis was conducted in all 3 countries from July 2018 to October 2018.MAIN OUTCOMES AND MEASURES The main outcome was postoperative opioid prescriptions filled within 7 days after discharge; the percentage of patients who filled a prescription, the total morphine milligram equivalent (MME) dose, and type of opioid dispensed were compared.RESULTS The study sample consisted of 129 379 patients in the United States, 84 653 in Canada, and 9802 in Sweden. Overall, 52 427 patients (40.5%) in the United States were men, with a mean (SD) age of 45.1 (12.7) years; in Canada, 25 074 patients (29.6%) were men, with a mean (SD) age of 43.5 (13.0) years; and in Sweden, 3314 (33.8%) were men, with a mean (SD) age of 42.5 (13.0). The proportion of patients in Sweden who filled an opioid prescription within the first 7 days after discharge for any procedure was lower than patients treated in the United States and Canada (Sweden, 1086 [11.1%]; United States, 98 594 [76.2%]; Canada, 66 544 [78.6%]; P