Variations in Postoperative Opioid Prescription Practices and Impact on Refill Prescriptions Following Lumbar Spine Surgery.

Autor: Goyal A; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA., Payne S; Department of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota, USA., Sangaralingham LR; Department of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota, USA., Jeffery MM; Department of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota, USA., Naessens JM; Department of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota, USA., Gazelka HM; Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, USA., Habermann EB; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA., Krauss WE; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA., Spinner RJ; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA., Bydon M; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA. Electronic address: bydon.mohamad@mayo.edu.
Jazyk: angličtina
Zdroj: World neurosurgery [World Neurosurg] 2021 Sep; Vol. 153, pp. e112-e130. Date of Electronic Publication: 2021 Jun 18.
DOI: 10.1016/j.wneu.2021.06.060
Abstrakt: Objective: Understanding postsurgical prescribing patterns and their impact on persistent opioid use is important for establishing reasonable opioid prescribing protocols. We aimed to determine national variation in postoperative opioid prescription practices following elective lumbar spine surgery and their impact on short-term refill prescriptions.
Methods: The OptumLabs Data Warehouse was queried from 2016 to 2017 for adults undergoing anterior lumbar fusion, posterior lumbar fusion, circumferential lumbar fusion, and lumbar decompression/discectomy for degenerative spine disease. Discharge opioid prescription fills were obtained and converted to morphine milligram equivalents (MMEs). Age- and sex-adjusted MMEs and frequency of discharge prescriptions >200 MMEs were determined for each U.S. census division and procedure type.
Results: The study included 43,572 patients with 37,894 postdischarge opioid prescription fills. There was wide variation in mean filled MMEs across all census divisions (anterior lumbar fusion: 774-1147 MMEs; posterior lumbar fusion: 717-1280 MMEs; circumferential lumbar fusion: 817-1271 MMEs; lumbar decompression/discectomy: 619-787 MMEs). A significant proportion of cases were found to have filled discharge prescriptions >200 MMEs (posterior lumbar fusion: 78.6%-95%; anterior lumbar fusion: 87.5%-95.6%; circumferential lumbar fusion: 81.4%-96.5%; lumbar decompression/discectomy: 80.5%-91%). Multivariable logistic regression showed that female sex and inpatient surgery were associated with a top-quartile discharge prescription and a short-term second opioid prescription fill, while the opposite was noted for elderly and opioid-naïve patients (all P ≤ 0.05). Prescriptions with long-acting opioids were associated with higher odds of a second opioid prescription fill (reference: nontramadol short-acting opioid).
Conclusions: In analysis of filled opioid prescriptions, we observed a significant proportion of prescriptions >200 MMEs and wide regional variation in postdischarge opioid prescribing patterns following elective lumbar spine surgery.
(Copyright © 2021 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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