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 阿片类药物处方和阿片类药物相关的过量死亡的率在美国已经三倍 过去25年。这种流行病已经增加了老年人，其中的住院率 从1993 - 2012年起，卵过量的过量剂量增长了五倍。使用量性的风险特别明显 成人，容易受到阿片类药物的副作用。尽管已引起了很大的关注 阿片类药物的不适当处方，阿片类药物的患者长期使用阿片类药物的方式是 主要是未知的。老年人接受阿片类药物的最常见环境之一是手术后。这 手术后的时期特别脆弱，用于阿片类药物，这是由于老年人的临床脆弱性 手术后，因为院后期期间通常涉及高度分散的护理过渡。 但是，在老年人手术后开处方处方的程度上，几乎没有数据存在， 处方和阿片类药物相关的不良事件的手术最为常见，外科医生的作用 以及医院级别的因素，以促进短期和长期处方使用。 许多人认为，物理处方行为的变化一直是阿片类药物流行的驱动力。 但是，尚无研究探讨个体外科医生在阿片类药物处方中的不同程度 手术及其对患者长期阿片类药物使用和相关不良结果的影响。 此外，很少的研究研究了术中和术后疼痛管理技术是否采用此类技术 作为区域性麻醉，可以减轻手术后的疼痛，也可能减少长期使用阿片类药物的使用和 手术后相关的不良结果。 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 - 包括短期与阿片类药物相关的不良事件以及对长期使用的过渡 - 没有Medicare行政索赔接受住院手术的未经opioid-opioid-nish的老年人。因为一个钥匙 确定外科医生在促进短期和长期阿片类药物后的影响方面的挑战 住院正在将提供者实践模式的影响与无法观察的患者特征分开 影响阿片类药物的使用，拟议的研究将开发出依赖的新型准实验方法 准随机分配住院的医疗保险受益人向不同阿片类药物处方的提供者 强度。拟议的研究还将开发准实验方法来研究不同的 手术期间疼痛管理的方法（使用区域麻醉）会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结果。 这项研究的结果将有助于确定老年人和 可以告知针对提供者改善的政策的需求，设计和潜在影响 老年人中外科治疗后处方的适当性。