Geospatial Analyses of Pain Intensity and Opioid Unit Doses Prescribed on the Day of Discharge Following Orthopedic Surgery.

Autor:	Tighe P; Departments of Anesthesiology., Modave F; Health Outcomes and Biomedical Informatics., Horodyski M; Orthopaedics and Rehabilitation, University of Florida College of Medicine, Gainesville, Florida., Marsik M; Data Science and Planning, University of Florida Health, Gainesville, Florida., Lipori G; Data Science and Planning, University of Florida Health, Gainesville, Florida., Fillingim R; Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, Florida., Hu H; Department of Epidemiology, University of Florida College of Medicine, Gainesville, Florida, USA., Hagen J; Orthopaedics and Rehabilitation, University of Florida College of Medicine, Gainesville, Florida.
Jazyk:	angličtina
Zdroj:	Pain medicine (Malden, Mass.) [Pain Med] 2020 Aug 01; Vol. 21 (8), pp. 1644-1662.
DOI:	10.1093/pm/pnz311
Abstrakt:	Objective: Inappropriate opioid prescribing after surgery contributes to opioid use disorder and risk of opioid overdose. In this cross-sectional analysis of orthopedic surgical patients, we examined the role of patient location on postoperative pain intensity and opioids prescribed on hospital discharge. Methods: We used geospatial analyses to characterize spatial patterns of mean pain intensity on the day of discharge (PiDoD) and opioid units prescribed on the day of discharge (OuPoD), as well as the effect of regional social deprivation on these outcomes. Results: At a 500-km radius from the surgery site, the Global Moran's I for PiDoD (2.71 × 10-3, variance = 1.67 × 10-6, P = 0.012) and OuPoD (2.19 × 10-3, SD = 1.87, variance = 1.66 × 10-6, P = 0.03) suggested significant spatial autocorrelation within each outcome. Local indicators of spatial autocorrelation, including local Moran's I, Local Indicator of Spatial Autocorrelation cluster maps, and Getis-Ord Gi* statistics, further demonstrated significant, specific regions of clustering both OuPoD and PiDoD. These spatial patterns were associated with spatial regions of area deprivation. Conclusions: Our results suggest that the outcomes of pain intensity and opioid doses prescribed exhibit varying degrees of clustering of patient locations of residence, at both global and local levels. This indicates that a given patient's pain intensity on discharge is related to the pain intensity of nearby individuals. Similar interpretations exist for OuPoD, although the relative locations of hot spots of opioids dispensed in a geographic area appear to differ from those of hot spots of pain intensity on discharge. (© 2019 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
Databáze:	MEDLINE
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