Enhanced recovery after surgery protocol and postoperative opioid prescribing for cesarean delivery: an interrupted time series analysis.
Enhanced recovery after surgery protocol and postoperative opioid prescribing for cesarean delivery: an interrupted time series analysis.
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DOI：
10.1186/s13741-021-00209-0
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发表时间：
2021-11-15
期刊：
影响因子：
--
通讯作者：
Chen CL
中科院分区：
文献类型：
--
作者：
Langnas EM;Matthay ZA;Lin A;Harbell MW;Croci R;Rodriguez-Monguio R;Chen CL
增强术后恢复（ERAS）途径已成为减少术后阿片类药物使用和降低外科患者发生新的持续性阿片类药物使用风险的有希望的策略。然而，ERAS实施与阿片类药物处方出院实践之间的关系尚不清楚。我们在一个大型学术中心对2015年2月至2019年12月期间接受剖宫产的年龄在18岁以上的opioid-naïve患者进行了回顾性观察性准实验研究。中断时间序列分析（ITSA）用于模拟与ERAS实施相关的止痛药处方变化，以解释预先存在的时间趋势。在实施ERAS后接受剖宫产的1473例患者（总计2249例）中，80.72%的患者接受了出院阿片类药物处方，而基线时为95.36%。eras前出院处方的每日口服吗啡当量（OME）每月降低0.48 OME （p<0.01）。施行ERAS后，患者的OME水平增加了35个（p<0.01），每月减少1.4个（p<0.01）。在处方中，61.35%的处方日总剂量大于90 OME，实施前为11.35% (p<0.01)，而ERAS实施后总剂量小于50 OME的处方从79.86%降至25.85% （p<0.01）。虽然ERAS的实施降低了剖宫产后接受出院阿片类药物处方的患者的总体比例，但对于接受阿片类药物处方的患者子集，ERAS的实施可能无意中增加了每日剂量大于90 OME的处方。这一发现突出了新政策实施后早期和持续评估的重要性。
Enhanced recovery after surgery (ERAS) pathways have emerged as a promising strategy to reduce postoperative opioid use and decrease the risk of developing new persistent opioid use in surgical patients. However, the association between ERAS implementation and discharge opioid prescribing practices is unclear. We conducted a retrospective observational quasi-experimental study of opioid-naïve patients aged 18+ undergoing cesarean delivery between February 2015 and December 2019 at a large academic center. An interrupted time series analysis (ITSA) was used to model the changes in pain medication prescribing associated with the implementation of ERAS to account for pre-existing temporal trends. Among the 1473 patients (out of 2249 total) who underwent cesarean delivery after ERAS implementation, 80.72% received a discharge opioid prescription vs. 95.36% at baseline. Pre-ERAS daily oral morphine equivalents (OME) on the discharge prescription decreased by 0.48 OME each month (p<0.01). There was a level shift of 35 more OME prescribed (p<0.01), followed by a monthly decrease of 1.4 OMEs per month after ERAS implementation (p<0.01). Among those who received a prescription, 61.35% received a total daily dose greater than 90 OME compared to 11.35% pre-implementation (p<0.01), while prescriptions with a total daily dose less than 50 OME decreased from 79.86 to 25.85% after ERAS implementation(p<0.01). Although ERAS implementation reduced the overall proportion of patients receiving a discharge opioid prescription after cesarean delivery, for the subset of patients receiving an opioid prescription, ERAS implementation may have inadvertently increased the prescribing of daily doses greater than 90 OME. This finding highlights the importance of early and continued evaluation after new policies are implemented.
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影响因子：
13.8
作者：
Peahl, Alex F.;Dalton, Vanessa K.;Waljee, Jennifer F.
通讯作者：
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CDC规定慢性疼痛的阿片类药物的指南 - 美国，2016年。
DOI：
10.1001/jama.2016.1464
发表时间：
2016-04-19
期刊：
JAMA
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