The Use of Novel Linked Databasesto Reduce Postoperative Opioid Use Among Patients Undergoing Inpatient Surgery

项目总结和摘要 手术使患者阿片类药物使用障碍和术后持续阿片类药物使用（PPOU）增加。 除了对患者健康的直接影响外，影响5-6%手术患者的PPOU还与 阿片类药物使用障碍、阿片类药物过量和手术死亡率/发病率的风险增加。这个问题 尤其是老年人。在美国，超过一半的外科手术发生在老年人中。 在成年人中，超过一半的老年人一生中需要手术一次， 老年人可能高达10%。有鉴于此，本项目的长期目标是描述 围手术期干预在降低长期结局风险（如PPOU和 阿片类药物使用障碍的老年人接受住院手术。虽然各种各样的干预措施， 据推测，阿片类药物可降低PPOU和其他术后阿片类药物结局的发生率，但仍存在 部分由于数据有限，对这些措施的有效性缺乏共识。尤其是， 为了获得关于围手术期护理的详细数据（即，术中给予的阿片类药物量）和以下数据 阿片类药物的长期疗效这项研究建立在一个新的数据集，连接两个数据集：多中心 围手术期结局组（MPOG），一项使用提取数据的大型多中心手术病例登记研究 从电子医疗记录和医疗保险按服务收费的患者的医疗索赔数据。这本小说 数据集结合了两个数据集的最佳方面：测量围手术期护理的能力和 随访患者，以评估长期阿片类药物的结果。我们将完成项目的目标 四个具体目标。首先，我们将通过开发可扩展的 纳入住院患者相关数据的通用工具（即阿片类药物给药和使用 非阿片类药物）。其次，我们将在一个单一的机构证明这些方法的可行性， 扩大到五个机构。第三，我们将使用增强数据集来评估关联 在术中介入之间（即，阿片类药物给药，使用神经阻滞）和长期阿片类药物 结果（即，PPOU和阿片类药物使用障碍）。最后，我们将使用增强数据集来评估 住院患者住院干预之间的关联（即，减少阿片类药物的使用， 出院）和长期阿片类药物的结果。该项目的调查结果将具有重要意义，因为它们将有助于指导 围手术期决策的关键方面，如术中和术后阿片类药物 局该项目的预期成果与HEAL倡议的目标相关，因为它们 将加强努力，减少PPOU的发生率和其他长期阿片类药物的结果，如阿片类药物的使用 disorder.至关重要的是，在整个项目中，我们将与利益相关者合作，以最大限度地发挥其影响，例如 与利益相关者协商，以决定要研究的干预措施，并与利益相关者合作， 将项目结果纳入临床指南和政策。

PROJECT SUMMARY AND ABSTRACT Surgery places patients at increased for opioid use disorder and persistent postoperative opioid use (PPOU). In addition to its direct impact on patient health, PPOU, which affects 5-6% of surgical patients, is associated with an increased risk of opioid use disorder, opioid overdose, and surgical mortality/morbidity. This issue has particular salience for older adults. Over half of all surgical procedures in the United States occur among older adults, over half of older adults will require a surgery once in their lifetime, and the incidence of PPOU among older adults can be as high as 10%. In this light, the long-term goal of this project is to characterize the effectiveness of perioperative interventions in reducing the risk of long-term outcomes such as PPOU and opioid use disorder among older adults undergoing inpatient surgery. While a wide variety of interventions has been hypothesized to reduce the incidence of PPOU and other post-operative opioid outcomes, there remains a lack of consensus about their effectiveness, in part due to data limitations. In particular, it is often challenging to obtain detailed data on perioperative care (i.e., amount of opioid administered intraoperatively) and data on long-term opioid outcomes. This study builds on a novel dataset that links two datasets: the Multicenter Perioperative Outcomes Group (MPOG), a large, multicenter registry of surgical cases using data extracted from electronic medical records and a healthcare claims data for Medicare fee-for-service patients. This novel dataset unites the best aspects of both datasets: the ability to measure perioperative care and the ability to follow patients in order to assess long-term opioid outcomes. We will accomplish the goals of the project through four specific aims. First, we will augment the existing dataset by developing scalable and generalizable tools to incorporate relevant data from the inpatient stay (i.e. opioid administration and the use of non-opioid adjuncts). Second, we will demonstrate the feasibility of these methods at a single institution and expand their use to five institutions. Third, we will use the augmented dataset to evaluate the association between intraoperative interventions (i.e., opioid administration, use of nerve blocks) and long-term opioid outcomes (i.e., PPOU and opioid use disorder). Finally, we will use the augmented dataset to evaluate the association between inpatient stay interventions (i.e., reduced opioid utilization, reduced prescribing at discharge) and long-term opioid outcomes. The findings of this project will be significant as they will help guide crucial aspects of perioperative decision-making such as intraoperative and postoperative opioid administration. The expected outcomes of this project are relevant to the goals of the HEAL Initiative as they will enhance efforts to reduce the incidence of PPOU and other long-term opioid outcomes such as opioid use disorder. Crucially, throughout the project, we will work with stakeholders to maximize its impact, such as consulting with stakeholders to decide the interventions to study and working with stakeholders to incorporate the project findings into clinical guidelines and policy.