Establishment and Implementation of Evidence-Based Opioid Prescribing Guidelines in Cardiac Surgery.

Autor:	Brescia AA; Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan. Electronic address: abrescia@med.umich.edu., Clark MJ; Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, Michigan., Theurer PF; Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, Michigan., Lall SC; Munson Medical Center, Traverse City, Michigan., Nemeh HW; Henry Ford Hospital, Detroit, Michigan., Downey RS; Mercy Health, Muskegon, Michigan., Martin DE; Ascension Borgess Hospital, Kalamazoo, Michigan., Dabir RR; Beaumont Hospital, Dearborn, Michigan., Asfaw ZE; Ascension Providence Hospital, Southfield, Michigan., Robinson PL; Beaumont Hospital, Troy, Michigan., Harrington SD; Henry Ford Macomb Hospital, Clinton Township, Michigan., Gandhi DB; McLaren Greater Lansing, Lansing, Michigan., Waljee JF; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan; Department of Surgery, University of Michigan, Ann Arbor, Michigan; Michigan Opioid Prescribing Engagement Network, Ann Arbor, Michigan., Englesbe MJ; Department of Surgery, University of Michigan, Ann Arbor, Michigan; Michigan Opioid Prescribing Engagement Network, Ann Arbor, Michigan., Brummett CM; Michigan Opioid Prescribing Engagement Network, Ann Arbor, Michigan; Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan., Prager RL; Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan; Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, Michigan., Likosky DS; Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan; Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, Michigan., Kim KM; Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan., Lagisetty KH; Department of Surgery, University of Michigan, Ann Arbor, Michigan.
Jazyk:	angličtina
Zdroj:	The Annals of thoracic surgery [Ann Thorac Surg] 2021 Oct; Vol. 112 (4), pp. 1176-1185. Date of Electronic Publication: 2020 Dec 04.
DOI:	10.1016/j.athoracsur.2020.11.015
Abstrakt:	Background: Despite the risk of new persistent opioid use after cardiac surgery, postdischarge opioid use has not been quantified and evidence-based prescribing guidelines have not been established. Methods: Opioid-naive patients undergoing primary cardiac surgery via median sternotomy between January and December 2019 at 10 hospitals participating in a statewide collaborative were selected. Clinical data were linked to patient-reported outcomes collected at 30-day follow-up. An opioid prescribing recommendation stratified by inpatient opioid use on the day before discharge (0, 1-3, or ≥4 pills) was implemented in July 2019. Interrupted time-series analyses were performed for prescription size and postdischarge opioid use before (January to June) and after (July to December) guideline implementation. Results: Among 1495 patients (729 prerecommendation and 766 postrecommendation), median prescription size decreased from 20 pills to 12 pills after recommendation release (P < .001), while opioid use decreased from 3 pills to 0 pills (P < .001). Change in prescription size over time was +0.6 pill/month before and -0.8 pill/month after the recommendation (difference = -1.4 pills/month; P = .036). Change in patient use was +0.6 pill/month before and -0.4 pill/month after the recommendation (difference = -1.0 pills/month; P = .017). Pain levels during the first week after surgery and refills were unchanged. Patients using 0 pills before discharge (n = 710) were prescribed a median of 0 pills and used 0 pills, while those using 1 to 3 pills (n = 536) were prescribed 20 pills and used 7 pills, and those using greater than or equal to 4 pills (n = 249) were prescribed 32 pills and used 24 pills. Conclusions: An opioid prescribing recommendation was effective, and prescribing after cardiac surgery should be guided by inpatient use. (Copyright © 2021 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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