Characterizing and Reducing New Persistent Opioid Use in Patients Undergoing Complex Major Surgery

摘要 阿片类药物的流行是一场公共卫生危机，由于药物滥用， 在过去的二十年里，无意的处方阿片类药物过量增加了450%。尽管主要 慢性疼痛管理和慢性疼痛阿片类药物处方实践的进展， 急性疼痛的处方并未减少。此外，外科手术后的阿片类药物处方 是新的持续性阿片类药物使用的共同进入途径。我们之前的研究显示， 在多种常见门诊手术后患者中新的持续阿片类药物使用，但 对重大外科手术后的病人和那些患有并发症的病人进行调查， 缺乏程序。术后病程复杂的患者往往要反复进行手术 并延长了住院时间，改变了他们疼痛减轻的轨迹， 这大大增加了他们在医院内外接触术后阿片类药物的机会。 在这项研究计划中，我们将重点收集来自几个全州数据库的数据，包括 通过密歇根外科质量合作组织（MSQC）和Blue Cross Blue Shield of Michigan（BCBSM）调查新的持续使用阿片类药物的程度 在复杂手术患者中的发展。此外，我们将定义术后 阿片类药物暴露在新的持续阿片类药物使用的发展中起作用，以及哪些患者水平因素是预测因素 新的阿片类药物依赖的风险。最后，我们将利用这些发现来开发， 为接受复杂外科手术的患者实施和评估循证疼痛计划。

Abstract The opioid epidemic represents a public health crisis that continues to worsen with mortality due to unintentional prescription opioid overdose increasing by 450% over the last two decades. Despite major advancements in the management of chronic pain and opioid prescription practices for chronic pain, prescriptions for acute pain have not declined. Additionally, opioid prescriptions following surgical operations represent a common entry pathway to new persistent opioid use. Our previous work has shown high rates of new persistent opioid use among patients following multiple common outpatient surgical procedures, but investigation into patients after major surgical operations and those that suffer complications from those procedures is lacking. Patients with complicated post-operative courses often undergo repeated procedures and have prolonged lengths of hospital stay, altering the trajectory with which their pain abates and potentially drastically increasing their exposure to post-operative opioid medications both in an out of the hospital. In this research proposal, we will focus on gathering data from several statewide databases including those available through the partnership between the Michigan Surgical Quality Collaborative (MSQC) as well as Blue Cross Blue Shield of Michigan (BCBSM) to investigate the magnitude of new persistent opioid use development among patients having complex surgery. In addition, we will define the role that post-operative opioid exposure plays in development of new persistent opioid use and what patient level factors are predictive of new opioid dependency in this high-risk group of patients. Finally, we will utilize these findings to develop, implement and assess an evidence-based pain plan for patients undergoing complex surgical procedures.