Use of Prescription Opioids Following Surgery and Associated Adverse Patient Outcomes in Older Adults

项目概要/摘要 在美国，阿片类药物处方和阿片类药物相关的过量死亡率翻了两番， 过去的25年这一流行病越来越多地影响到老年人， 1993-2012年，类阿片过量增加了五倍。阿片类药物使用的风险对于老年人尤其明显 成年人，他们容易受到阿片类药物副作用的影响。尽管人们对 阿片类药物处方不当，阿片类药物初治患者长期使用阿片类药物的方式是 大部分是未知的。老年人接受阿片类药物最常见的情况之一是手术后。的 手术后的一段时间是阿片类药物使用的一个特别脆弱的时期，这既是因为老年人的临床脆弱性 此外，由于住院后阶段往往涉及高度分散的护理过渡， 然而，关于老年人手术后阿片类药物处方的程度的数据很少， 处方和阿片类药物相关不良事件最常见的手术，以及外科医生的作用- 和医院层面的因素，有助于短期和长期处方阿片类药物的使用。 许多人认为，医生处方行为的变化是阿片类药物流行的驱动因素。 然而，没有研究探讨了个体外科医生在阿片类药物处方方面的差异程度， 手术以及这种变化对患者长期使用阿片类药物和相关不良后果的影响。 此外，很少有研究探讨术中和术后疼痛管理技术，如 因为局部麻醉可以减少手术后的疼痛，也可以减少长期阿片类药物的使用， 手术后的相关不良后果。 拟议的研究将量化手术后阿片类药物处方的短期和长期影响 - 包括短期阿片类药物相关不良事件和过渡到长期使用-在以前的 使用Medicare行政索赔进行住院手术的阿片类药物初治老年人。因为钥匙 在确定外科医生对短期和长期阿片类药物使用的影响方面存在挑战， 住院治疗是从不可观察的患者特征中分离出提供者实践模式的影响 影响阿片类药物使用，拟议的研究将开发新的准实验方法， 将住院医疗保险受益人准随机分配给不同阿片类药物处方的提供者 强度。拟议中的研究还将开发准实验方法，以研究 手术期间的疼痛管理方法（使用区域麻醉）影响术后阿片类药物 使用和潜在的下游阿片类药物相关的不良后果。 这项研究的结果将有助于确定老年人术后使用阿片类药物的风险， 可以告知政策的需求，设计和潜在影响，目标是提供者，以改善 老年人手术后阿片类药物处方的适当性。

Project Summary/Abstract Rates of opioid prescribing and opioid-related overdose deaths have quadrupled in the United States over the past 25 years. This epidemic has increasingly affected older adults, among whom hospitalization rates for opioid overdoses grew five-fold from 1993-2012. Risks of opioid use are particularly pronounced for older adults, who are vulnerable to opioids’ side effects. Although substantial attention has been placed on inappropriate prescribing of opioids, the ways in which opioid-naïve patients develop long-term opioid use are mostly unknown. One of the most common settings for older adults to receive opioids is after surgery. The period after surgery is a particularly vulnerable one for opioid use, both because of older adults’ clinical fragility after surgery and because the post-hospitalization period often involves a highly fragmented transition of care. However, little data exist on the extent to which opioids are prescribed following surgery among older adults, surgeries for which prescribing and opioid-related adverse events are most common, and the role of surgeon- and hospital-level factors in contributing to short- and long-term prescription opioid use. Many argue that variation in physician prescribing behavior has been a driver of the opioid epidemic. However, no research has explored the extent to which individual surgeons vary in opioid prescribing following surgery and the implications of that variation for patients’ long-term opioid use and related adverse outcomes. In addition, little research has examined whether intra- and post-operative pain management techniques such as regional anesthesia, which may reduce pain following surgery, may also reduce long-term opioid use and related adverse outcomes after surgery. The proposed research will quantify the short- and long-term effects of opioid prescribing following surgery – including short-term opioid-related adverse events and the transition to long-term use – among previously opioid-naïve older adults who undergo inpatient surgery using Medicare administrative claims. Because a key challenge in identifying the effect of surgeons in contributing to short- and long-term opioid use after hospitalization is separating the effects of provider practice patterns from unobservable patient characteristics that affect opioid use, the proposed research will develop novel quasi-experimental approaches that rely on quasi-random assignment of hospitalized Medicare beneficiaries to providers of varying opioid-prescribing intensity. The proposed research will also develop quasi-experimental methods to study how different approaches to pain management during surgery (use of regional anesthesia) influence post-operative opioid use and potentially downstream opioid-related adverse outcomes. Results from this research will help define the risks of post-operative opioid use among older adults and can inform the need, design and potential impact of policies that target providers to improve the appropriateness of post-surgical opioid prescribing among older adults.