Correlation Between 24-Hour Predischarge Opioid Use and Amount of Opioids Prescribed at Hospital Discharge
Correlation Between 24-Hour Predischarge Opioid Use and Amount of Opioids Prescribed at Hospital Discharge
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DOI：
10.1001/jamasurg.2017.4859
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发表时间：
2018-02-01
期刊：
影响因子：
16.9
通讯作者：
Tornetta, Paul, III
中科院分区：
文献类型：
--
作者：
Chen, Eric Y.;Marcantonio, Andrew;Tornetta, Paul, III
美国正在经历阿片类药物滥用的流行。阿片类药物过量处方的医生可能会导致这种流行病。结论为了确定是否有一个术后病人的24小时出院前阿片类药物的使用和阿片类药物的量规定在出院，并确定病人的数量谁没有使用阿片类药物出院前，但仍然规定阿片类药物出院后。设计，设置，和参与者这项横断面研究进行了一项回顾性记录审查的18 343术后患者在波士顿医疗中心和Lahey医院和医疗中心伯灵顿校区出院回家后，术后住院至少24小时。波士顿医学中心数据集的数据收集时间为2014年5月22日至2016年6月30日，以及2015年3月23日至2016年9月7日，在勒西医院和医疗中心Burlington Campus数据集。暴露手术需要术后住院时间超过24小时。主要结果和指标主要结果指标是患者的出院前24小时阿片类药物使用情况和出院时处方的阿片类药物总量。潜在过量处方定义为出院前24小时内未使用阿片类药物但出院后仍处方阿片类药物的患者数量。（10 069名妇女和8 274名男子;平均年龄52.2岁，接受了21452例外科手术，术后患者出院前24小时阿片类药物使用量在出院时处方阿片类药物量有很大差异。共有6548例患者（35/%）在出院前24小时内未使用阿片类药物;然而，其中2988例患者（45.6%）在出院时处方阿片类药物，表明可能过度处方。潜在过度处方率最高的服务（产科[校正比值比（AOR），1146; 95% CI，2.094-4/65]和妇科[AOR，2.355; 95% CI，1.663-3.390]，骨科[AOR，0.943; 95% CI，0.719-1.242]和整形外科[AOR，0.733; 95% CI，0.334-1.682]）通常出院时仍使用阿片类药物的患者比例最高。儿科手术是唯一没有任何潜在过度处方病例的服务（AOR，2.09 x 10（-7）; 95%CI，0.000-0.016）。结论和相关性阿片类药物不以患者特异性方式定期处方给术后患者。在几乎所有外科专业中，手术后经常发生潜在的阿片类药物过度处方。
IMPORTANCE The United States is experiencing an opioid abuse epidemic. Opioid overprescription by physicians may contribute to this epidemic.OBJECTIVES To determine if there was a correlation between a postoperative patient's 24-hour predischarge opioid use and the amount of opioids prescribed at hospital discharge and to determine the number of patients who used no opioids prior to discharge but were still prescribed opioids after hospital discharge.DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study performed a retrospective record review of 18 343 postoperative patients at Boston Medical Center and Lahey Hospital and Medical Center-Burlington Campus who were discharged home after a postoperative inpatient admission of at least 24 hours. Data collection spanned from May 22, 2014, to June 30, 2016, in the Boston Medical Center data set and from March 23, 2015, to September 7, 2016, in the Lahey Hospital and Medical Center-Burlington Campus data set.EXPOSURES Surgery requiring a postoperative inpatient hospital stay longer than 24 hours.MAIN OUTCOMES AND MEASURES The main outcome measures were the patient's 24-hour predischarge opioid use and the total quantity of opioids prescribed at hospital discharge. Potential overprescription was defined as the number of patients who used no opioids in the 24 hours prior to hospital discharge but were still prescribed opioids after hospital discharge.RESULTS Among the 18 343 patients (10 069 women and 8274 men; mean age, 52.2 years) who underwent 21 452 surgical procedures, there was wide variation in the amount of opioids prescribed at hospital discharge given a postoperative patient's 24-hour predischarge opioid use. A total of 6548 patients (35/%) used no opioids in the 24 hours prior to hospital discharge; however, 2988 of these patients (45.6%) were prescribed opioids at hospital discharge, suggesting potential overprescription. Services that had the highest rates of potential overprescription (obstetrics [adjusted odds ratio (AOR), 1146; 95% Cl, 2.094-4/65] and gynecology [AOR, 2.355; 95% Cl, 1.663-3.390], orthopedics [AOR, 0.943; 95% CI, 0.719-1.242], and plastic surgery [AOR, 0.733; 95% Cl, 0.334-1.682]) generally had the highest rates of patients still using opioids at hospital discharge. Pediatric surgery was the only service that did not have any cases of potential overprescription (AOR, 2.09 x 10(-7); 95% CI, 0.000-0.016).CONCLUSIONS AND RELEVANCE Opioids are not regularly prescribed in a patient-specific manner to postoperative patients. Potential opioid overprescription occurs regularly after surgery among almost all surgical specialties.