The association of multimodal analgesia and high-risk opioid discharge prescriptions in opioid-naive surgical patients.
The association of multimodal analgesia and high-risk opioid discharge prescriptions in opioid-naive surgical patients.
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DOI：
10.1186/s13741-021-00230-3
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发表时间：
2021-12-15
期刊：
影响因子：
--
通讯作者：
Chen CL
中科院分区：
文献类型：
--
作者：
Langnas E;Rodriguez-Monguio R;Luo Y;Croci R;Dudley RA;Chen CL
阿片类药物和多模式镇痛被广泛用于治疗术后疼痛。然而，对于阿片类药物naïve手术患者的住院疼痛控制的改善与高风险（每日OME）出院阿片类药物处方的相关性知之甚少。我们对2012年6月至2018年12月在一家大型学术医疗中心接受手术的成人opioid-naïve患者进行了回顾性观察研究。我们使用多变量logistic回归来评估出院前24小时内使用的多模式镇痛药物是否与高危阿片类药物出院处方的减少有关。我们确定了接受高危出院阿片类药物处方的其他危险因素。在32,511名患者中，83%的患者出院时使用阿片类药物处方。2013年，34.1%的出院阿片类药物处方患者接受了高风险处方，到2018年这一比例下降到17.7%。在住院最后24小时内使用多模式镇痛药的人数逐年增加，到2018年，超过80%的患者至少使用一种多模式镇痛药。放电前24小时内消耗的平均OME在2013年达到峰值31，到2018年稳步下降至19.8。出院前24 h使用对乙酰氨基酚与出院时高危处方有显著相关性（p < 0.01）。出院前24小时内服用的mes是接受高风险出院处方的重要预测因子，即使是低剂量。与接受高风险阿片类药物出院处方相关的其他因素包括男性性别、种族、焦虑症史和出院服务。2012年至2018年期间，住院外科患者出院前24小时内使用多模式镇痛方案的情况有所增加。同时，出院前阿片类药物使用减少。尽管取得了这些进展，但大约五分之一的出院处方是高风险的（每日OME 90英镑）。此外，我们发现在阿片类药物初次手术患者中，出院阿片类药物的处方高于住院阿片类药物的要求仍然很常见。在考虑可能适用于个别手术患者的出院阿片类药物处方的总OME和每日OME时，提供者应考虑到出院前阿片类药物的消耗和多模式镇痛的使用。在线版本包含补充材料，可在10.1186/s13741-021-00230-3获得。
Opioids and multimodal analgesia are widely administered to manage postoperative pain. However, little is known on how improvements in inpatient pain control are correlated with high-risk (> 90 daily OME) discharge opioid prescriptions for opioid naïve surgical patients. We conducted a retrospective observational study of adult opioid-naïve patients undergoing surgery from June 2012 through December 2018 at a large academic medical center. We used multivariate logistic regression to assess whether multimodal analgesic drugs consumed in the 24 h prior to discharge was associated with a reduction in high-risk opioid discharge prescriptions. We identified other risk factors for receiving a high-risk discharge opioid prescription. Among the 32,511 patients, 83% of patients were discharged with an opioid prescription. In 2013, 34.1% of patients with a discharge opioid prescription received a high-risk prescription and this declined to 17.7% by 2018. Use of multimodal analgesic agents during the final 24 h of hospitalization increased each year, with over 80% receiving at least one multimodal analgesic agent by 2018. The median OME consumed in the 24 h prior to discharge peaked in 2013 at 31 and steadily decreased to 19.8 by 2018. There was a significant association between the use of acetaminophen in the 24 h prior to discharge and a high-risk prescription at discharge (p < 0.01). OMEs consumed in the 24 h prior to discharge was a significant predictor of receiving a high-risk discharge prescription, even at low doses. Other factors associated with receipt of a high-risk discharge opioid prescription included male gender, race, history of anxiety disorder, and discharge service. Use of multimodal analgesia regimens in hospitalized surgical patients in the 24 h prior to hospital discharge increased between 2012 and 2018. Simultaneously, opioid use prior to hospital discharge decreased. Despite these gains, approximately one in five discharge prescriptions was high-risk (> 90 daily OME). In addition, we found that prescribing of discharge opioids above inpatient opioid requirements remains common in opioid naive surgical patients. Providers should account for pre-discharge opioid consumption and use of multimodal analgesia when considering the total and daily OME’s that may be appropriate for an individual surgical patient on the discharge opioid prescription. The online version contains supplementary material available at 10.1186/s13741-021-00230-3.
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影响因子：
16.9
作者：
Chen, Eric Y.;Marcantonio, Andrew;Tornetta, Paul, III
通讯作者：
Tornetta, Paul, III
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：
3.6
作者：
Rosero, Eric B.;Joshi, Girish P.
通讯作者：
Joshi, Girish P.
影响因子：
7.8
作者：
Militsakh, Oleg;Lydiatt, William;Panwar, Aru
通讯作者：
Panwar, Aru
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
影响因子：
--
作者：
Dowell D;Haegerich TM;Chou R
通讯作者：
Chou R