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

老年人手术后处方阿片类药物的使用和相关的不良患者结果

• 批准号: 10017798
• 负责人: Anupam Bapu Jena
• 金额: $ 67.75万
• 依托单位: HARVARD MEDICAL SCHOOL
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-15 至 2022-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10017798
• 关键词: Adoption; Adult; Adverse effects; Adverse event; Affect; Attention; Behavior; Caring; Centers for Disease Control and Prevention (U.S.); Characteristics; Chronic; Clinical; Conduction Anesthesia; Data; Dependence; Dose; Elderly; Emergency Situation; Epidemic; Fracture; General Anesthesia; Health system; Hospitalization; Hospitals; Individual; Label; Lead; Local anesthesia; Long-Term Effects; Measurement; Medicare; Methods; Nature; Operative Surgical Procedures; Opiate Addiction; Opioid; Pain; Pain management; Patient-Focused Outcomes; Patients; Pattern; Physicians; Policies; Postoperative Pain; Postoperative Period; Probability; Procedures; Provider; Public Health; Reporting; Research; Research Methodology; Resources; Risk; Role; Safety; Selection Bias; Standardization; Surgeon; Techniques; Time; United States; Variant; adverse outcome; authority; base; beneficiary; design; experimental study; falls; hip surgery; hospitalization rates; human old age (65+); improved; inpatient surgery; mortality; novel; opioid epidemic; opioid overdose; opioid use; overdose death; pain reduction; pain sensation; patient variability; peer; prescription opioid; prescription opioid abuse; side effect; treatment duration; trend

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.

项目摘要/摘要 年，美国阿片类药物处方和与阿片类药物相关的过量死亡率翻了两番。 过去的25年里。这一流行病日益影响老年人，其中老年人的住院率 阿片类药物过量从1993年到2012年增长了五倍。使用阿片类药物的风险在老年人中尤为明显 成人，他们容易受到阿片类药物副作用的影响。尽管已经把大量的注意力放在 不适当的阿片类药物处方，阿片类药物幼稚患者长期使用阿片类药物的方式有 大部分都是未知的。老年人接受阿片类药物最常见的设置之一是在手术后。这个 术后是阿片类药物使用的一个特别脆弱的时期，这两个原因都是因为老年人的临床脆弱性 在手术后，由于住院后的过渡期往往涉及高度分散的护理过渡。 然而，关于老年人手术后开阿片类药物的程度的数据很少， 处方和阿片类药物相关不良事件最常见的手术，以及外科医生的角色- 以及医院一级的因素，促进短期和长期处方阿片类药物的使用。 许多人认为，医生处方行为的差异是阿片类药物流行的一个驱动因素。 然而，还没有研究探索外科医生在以下情况下开阿片类药物处方的不同程度。 手术以及这种变异对患者长期使用阿片类药物和相关不良后果的影响。 此外，很少有研究检查手术中和手术后的疼痛管理技术是否 因为区域麻醉可以减少手术后的疼痛，也可以减少长期使用阿片类药物和 术后相关不良后果。 这项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。 -包括与阿片类药物有关的短期不良事件和向长期使用的过渡--在以前 阿片类药物--使用医疗保险管理索赔进行住院手术的天真老年人。因为一把钥匙 在确定外科医生在术后短期和长期使用阿片类药物方面的作用方面面临的挑战 住院治疗是将提供者实践模式的影响与无法观察到的患者特征分开 影响阿片类药物使用，拟议的研究将开发新的准实验方法，依赖于 住院医疗保险受益人对不同阿片类药物处方提供者的准随机分配 强度。拟议的研究还将开发准实验方法来研究不同之处 术中疼痛处理方法(区域麻醉的使用)对术后阿片类药物的影响 使用和潜在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，以及 可以告知针对提供商的政策的需求、设计和潜在影响，以改善 老年人术后阿片类药物处方的适宜性。