Opioid prescribing patterns among postpartum women.
Opioid prescribing patterns among postpartum women.
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DOI：
10.1016/j.ajog.2018.04.003
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发表时间：
2018-07
影响因子：
9.8
通讯作者：
Yee LM
中科院分区：
文献类型：
--
作者：
Badreldin N;Grobman WA;Chang KT;Yee LM
妇女通常在住院后获得阿片类药物处方。美国阿片类药物流行的增加强调了更好地了解处方模式的重要性。虽然分娩是美国最常见的住院原因，但关于产后出院时开具阿片类药物处方的知识不足。在一个大的、多样化的队列中描述分娩后出院时阿片类药物的处方模式，并描述这些模式与出院前客观和主观疼痛测量的关系。这是一项回顾性队列研究，在一个单一的，高容量三级保健中心一年期间的所有分娩。如果妇女最近有阿片类药物使用的证据，或者她们的分娩、分娩或产后过程中有罕见的、预计会增加疼痛的非常规事件，则排除在分析之外。对医疗记录进行了人口统计和临床数据查询，包括出院时是否提供了阿片类药物处方，如果有，则提供了该处方的详细信息。主要结果是出院时处方的阿片类吗啡毫克当量，分别用于阴道分娩和剖宫产分娩的妇女。在接受处方的女性中，我们额外评估了处方数量与主观（患者报告的疼痛评分）和客观（住院最后24小时内住院阿片类药物需求）疼痛评估之间的关系。进行了描述性和双变量分析。在总共12,611名妇女中，有12,326名符合纳入条件。在9038名阴道分娩妇女和3288名剖宫产妇女中，30.4%和86.7%的妇女在出院时分别接受了阿片类药物处方。在接受出院阿片类药物处方的妇女中，阴道分娩后接受的吗啡毫克当量中位数为200（四分位数范围：120至300），剖宫产后接受的吗啡毫克当量中位数为300（四分位数范围：200至300）。在接受阿片类药物处方的妇女中，近一半（45.7%）阴道分娩后妇女和18.5%剖宫产后妇女在最后住院日使用了0 MME。同样，分别有26.5%和18.5%的女性在阴道分娩和剖宫产后出院前的疼痛评分为0分（满分10分）。无论递送方式如何，在报告疼痛评分为0分（满分10分）的患者和报告出院前疼痛评分大于0分（满分10分）的患者之间，处方阿片类药物的数量没有差异。同样，对于剖宫产的妇女，在出院前24小时内使用0毫克吗啡当量的妇女和使用大于0毫克吗啡当量的妇女之间，吗啡当量的处方剂量没有差异。产后妇女通常在产后出院时服用阿片类药物。在分娩后出院时开出的吗啡毫克当量处方范围很广，这突出表明缺乏标准化。此外，不考虑分娩前的客观和主观疼痛测量，女性在阴道分娩或剖宫产后接受了等量的处方吗啡毫克。
Women commonly receive opioid prescriptions following hospitalization. The rise of the opioid epidemic in the United States underscores the importance of a better understanding of prescribing patterns. Although delivery is the most frequent reason for hospitalization in the United States, there is inadequate knowledge regarding opioid prescribing at postpartum hospital discharge. To describe opioid prescribing patterns at the time of discharge following delivery in a large, diverse cohort, and to describe the relationship of these patterns with objective and subjective measures of pain prior to discharge. This is a retrospective cohort study of all deliveries at a single, high volume tertiary care center over a one-year period. Women were excluded from analysis if they had evidence of recent opioid use, or their labor, delivery or postpartum course was notable for rare, non-routine events anticipated to increase pain. Medical records were queried for demographic and clinical data, including whether an opioid prescription was provided at discharge, and if so, details of that prescription. The primary outcome was amount of opioid morphine milligram equivalents prescribed at discharge, described separately for women post vaginal and cesarean deliveries. Among women who received a prescription, we additionally assessed associations between prescription quantity and subjective (patient-reported pain score) and objective (inpatient opioid requirement during the final 24 hours of hospitalization) assessments of pain. Descriptive and bivariable analyses were performed. Of the total 12,611 women, 12,326 were eligible for inclusion. Of 9,038 women post vaginal delivery and 3,288 women post cesarean delivery, 30.4% and 86.7% received an opioid prescription at discharge, respectively. Of women receiving discharge opioid prescriptions, median morphine milligram equivalents received was 200 (interquartile range: 120 to 300) following vaginal and 300 (interquartile range: 200 to 300) following cesarean delivery. Nearly half (45.7%) of women post vaginal delivery and 18.5% of women post cesarean delivery who received an opioid prescription used 0 MME during the final hospital day. Similarly, 26.5% and 18.5% of women post vaginal and cesarean delivery, respectively, reported a pain score of 0 out of 10 prior to discharge. Regardless of delivery mode, the amount of opioids prescribed did not differ between those who reported a pain score of 0 out of 10 and those who reported a pain score of greater than 0 out of 10 immediately prior to discharge. Similarly, for women who underwent cesarean delivery, the morphine milligram equivalents prescribed did not differ between those who used 0 morphine milligram equivalents and those who used great than 0 in the 24 hours prior to hospital discharge. Postpartum women are commonly prescribed opioids at the time of postpartum hospital discharge. There is a wide range of morphine milligram equivalents prescribed at hospital discharge following delivery, highlighting a lack of standardization. Furthermore, regardless of objective and subjective measures of pain prior to discharge, women received similar amounts of prescription morphine milligram equivalents following either vaginal or cesarean deliveries.
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影响因子：
7.2
作者：
Grobman, William A.;Bailit, Jennifer L.;Van Dorsten, J. Peter
通讯作者：
Van Dorsten, J. Peter
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
影响因子：
7.2
作者：
Bateman, Brian T.;Cole, Naida M.;Leffert, Lisa R.
通讯作者：
Leffert, Lisa R.
影响因子：
56.9
作者：
TUKEY, JW
通讯作者：
TUKEY, JW
影响因子：
7.2
作者：
Osmundson, Sarah S.;Schornack, Leslie A.;Richardson, Michael G.
通讯作者：
Richardson, Michael G.