Association of the 2016 US Centers for Disease Control and Prevention Opioid Prescribing Guideline With Changes in Opioid Dispensing After Surgery.
Association of the 2016 US Centers for Disease Control and Prevention Opioid Prescribing Guideline With Changes in Opioid Dispensing After Surgery.
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DOI：
10.1001/jamanetworkopen.2021.11826
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发表时间：
2021-06-01
影响因子：
13.8
通讯作者：
Neuman MD
中科院分区：
文献类型：
--
作者：
Sutherland TN;Wunsch H;Pinto R;Newcomb C;Brensinger C;Gaskins L;Bateman BT;Neuman MD
2016年美国疾病控制和预防中心（CDC）发布的阿片类药物治疗慢性疼痛的指南是否与手术后阿片类药物分配的变化有关？在这项对361556例接受8种常见手术的阿片类药物初治患者进行的横断面研究中，时间序列分析发现，在指南发布后的2年内，手术后分发的阿片类药物量逐渐减少，而在指南发布前的2年内，阿片类药物量增加。这些发现表明，2016年CDC指南的发布与一系列外科手术中术后阿片类药物分配的减少相吻合，可能与术后疼痛管理中阿片类药物过量处方的减少有关。这项横断面研究评估了2016年3月美国疾病控制和预防中心（CDC）阿片类药物处方指南发布前后术后阿片类药物分配的变化。虽然2016年美国疾病控制和预防中心（CDC）关于阿片类药物治疗慢性疼痛的指南并不旨在解决术后疼痛管理问题，但观察员注意到该指南可能会影响术后阿片类药物处方。评估2016年3月CDC指南发布前后术后阿片类药物分配的变化。这项横断面研究包括361556名阿片类药物初治患者，他们在2014年3月16日至2018年3月15日期间接受了8种常见外科手术中的1种。从私人保险数据库中检索数据，并进行回顾性中断时间序列分析。数据分析于2014年3月至2018年4月进行。在2016年CDC指南发布之前和之后测量了结果。主要结局是术后7天内首次处方中分配的阿片类药物总量（吗啡毫克当量（MME））;次要结局包括处方阿片类药物总量和术后30天内重新填充任何阿片类药物的发生率。为了表征绝对阿片类药物分配水平，将初始处方中分配的量与现有的程序特定建议进行比较。样本包括361556例接受8种普通和整形外科手术的阿片类药物初治患者; 164009例（45.4%）为男性患者，样本的中位（四分位距）年龄为58岁（45至69岁）。在CDC指南发布后的2年内，手术后首次处方中分配的阿片类药物总量有所下降，而前2年则呈上升趋势。（释放前趋势：1.43 MME/月; 95% CI，0.62至2.24 MME/月; P = .001;释放后趋势：-2.18 MME/月; 95% CI，-3.01至-1.35 MME/月; P < .001;趋势变化：-3.61 MME/月; 95% CI，-4.87至-2.35 MME/月; P < .001）。接受髋关节或膝关节置换术的患者的初始分配量趋势变化最大（-8.64 MME/月; 95% CI，-11.68至-5.60 MME/月; P < .001）。随时间推移，观察到再填充率变化极小（净变化：每月0.14%; 95% CI，每月0.06%至0.23%; P = .001）。在整个期间，处方的绝对量仍然很高，近一半的患者（47.7%; 95% CI，47.4%-47.9%）在指南后期间接受治疗，根据可用的手术特定建议，至少接受两倍于预期治疗术后疼痛的初始阿片类药物剂量。在这项研究中，在2016年CDC指南发布后，手术后的阿片类药物分配大幅减少，而在2年前则呈上升趋势。在研究期间，手术处方的绝对量仍然很高，支持需要进一步努力改善术后疼痛管理。
Was the release of the 2016 US Centers for Disease Control and Prevention (CDC) guideline for prescribing opioids for chronic pain associated with changes in opioid dispensing after surgery? In this cross-sectional study of 361 556 opioid-naive patients undergoing 8 common surgical procedures, time-series analysis found that the amount of opioid dispensed after surgery decreased progressively in the 2 years after the guideline release, whereas it was increasing in the 2 years prior. These findings suggest that the release of the 2016 CDC guideline coincided with a decrease in postoperative opioid dispensing across a range of surgical procedures and may have been associated with decreases in overprescribing of opioids for postoperative pain management. This cross-sectional study assesses changes in postoperative opioid dispensing after vs before the US Centers for Disease Control and Prevention (CDC) guideline for prescribing opioids was released in March 2016. While the 2016 US Centers for Disease Control and Prevention (CDC) guideline for prescribing opioids for chronic pain was not intended to address postoperative pain management, observers have noted the potential for the guideline to have affected postoperative opioid prescribing. To assess changes in postoperative opioid dispensing after vs before the CDC guideline release in March 2016. This cross-sectional study included 361 556 opioid-naive patients who received 1 of 8 common surgical procedures between March 16, 2014, and March 15, 2018. Data were retrieved from a private insurance database, and a retrospective interrupted time series analysis was conducted. Data analysis was conducted from March 2014 to April 2018. Outcomes were measured before and after release of the 2016 CDC guideline. The primary outcome was the total amount of opioid dispensed in the first prescription filled within 7 days following surgery in morphine milligram equivalents (MMEs); secondary outcomes included the total amount of opioids prescribed and the incidence of any opioid refilled within 30 days after surgery. To characterize absolute opioid dispensing levels, the amount dispensed in initial prescriptions was compared with available procedure-specific recommendations. The sample included 361 556 opioid-naive patients undergoing 8 general and orthopedic surgical procedures; 164 009 (45.4%) were male patients, and the median (interquartile range) age of the sample was 58 (45 to 69) years. The total amount of opioids dispensed in the first prescription after surgery decreased in the 2 years following the CDC guideline release, compared with an increasing trend in the 2 years prior (prerelease trend: 1.43 MME/month; 95% CI, 0.62 to 2.24 MME/month; P = .001; postrelease trend: −2.18 MME/month; 95% CI, −3.01 to −1.35 MME/month; P < .001; trend change: −3.61 MME/month; 95% CI, −4.87 to −2.35 MME/month; P < .001). Changes in initial dispensing amount trends were greatest for patients undergoing hip or knee replacement (−8.64 MME/month; 95% CI, −11.68 to −5.60 MME/month; P < .001). Minimal changes were observed in rates of refills over time (net change: 0.14% per month; 95% CI, 0.06% to 0.23% per month; P = .001). Absolute amounts prescribed remained high throughout the period, with nearly half of patients (47.7%; 95% CI, 47.4%-47.9%) treated in the postguideline period receiving at least twice the initial opioid dose anticipated to treat postoperative pain based on available procedure-specific recommendations. In this study, opioid dispensing after surgery decreased substantially after the 2016 CDC guideline release, compared with an increasing trend during the 2 years prior. Absolute amounts prescribed for surgery remained high during the study period, supporting the need for further efforts to improve postoperative pain management.
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影响因子：
5.7
作者：
Hah JM;Bateman BT;Ratliff J;Curtin C;Sun E
通讯作者：
Sun E
DOI：
10.1046/j.1365-2710.2002.00430.x
发表时间：
2002-08-01
影响因子：
2
作者：
Wagner, AK;Soumerai, SB;Ross-Degnan, D
通讯作者：
Ross-Degnan, D
影响因子：
39.2
作者：
Bohnert, Amy S. B.;Guy, Gery P., Jr.;Losby, Jan L.
通讯作者：
Losby, Jan L.
影响因子：
9
作者：
Hill, Maureen V.;McMahon, Michelle L.;Barth, Richard J. Jr
通讯作者：
Barth, Richard J. Jr
影响因子：
3
作者：
Elixhauser, A;Steiner, C;Coffey, RN
通讯作者：
Coffey, RN