Opioid analgesic use after ambulatory surgery: a descriptive prospective cohort study of factors associated with quantities prescribed and consumed.

Autor:	Shanahan CW; Section of General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts, USA christopher.shanahan@bmc.org., Reding O; Section of General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts, USA., Holmdahl I; Section of General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts, USA., Keosaian J; Section of General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts, USA., Xuan Z; Community Health Sciences, Boston University, Boston, Massachusetts, USA., McAneny D; Department of General Surgery, Boston University School of Medicine, Boston, Massachusetts, USA., Larochelle M; Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA., Liebschutz J; Division of General Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Jazyk:	angličtina
Zdroj:	BMJ open [BMJ Open] 2021 Aug 12; Vol. 11 (8), pp. e047928. Date of Electronic Publication: 2021 Aug 12.
DOI:	10.1136/bmjopen-2020-047928
Abstrakt:	Objectives: To prospectively characterise: (1) postoperative opioid analgesic prescribing practices; (2) experience of patients undergoing elective ambulatory surgeries and (3) impact of patient risk for medication misuse on postoperative pain management. Design: Longitudinal survey of patients 7 days before and 7-14 days after surgery. Setting: Academic urban safety-net hospital. Participants: 181 participants recruited, 18 surgeons, follow-up data from 149 participants (82% retention); 54% women; mean age: 49 years. Interventions: None. Primary and Secondary Outcome Measures: Total morphine equivalent dose (MED) prescribed and consumed, percentage of unused opioids. Results: Surgeons postoperatively prescribed a mean of 242 total MED per patient, equivalent to 32 oxycodone (5 mg) pills. Participants used a mean of 116 MEDs (48%), equivalent to 18 oxycodone (5 mg) pills (~145 mg of oxycodone remaining per patient). A 10-year increase in patient age was associated with 12 (95% CI (-2.05 to -0.35)) total MED fewer prescribed opioids. Each one-point increase in the preoperative Graded Chronic Pain Scale was associated with an 18 (6.84 to 29.60) total MED increase in opioid consumption, and 5% (-0.09% to -0.005%) fewer unused opioids. Prior opioid prescription was associated with a 55 (5.38 to -104.82) total MED increase in opioid consumption, and 19% (-0.35% to -0.02%) fewer unused opioids. High-risk drug use was associated with 9% (-0.19% to 0.002%) fewer unused opioids. Pain severity in previous 3 months, high-risk alcohol, use and prior opioid prescription were not associated with postoperative prescribing practices. Conclusions: Participants with a preoperative history of chronic pain, prior opioid prescription, and high-risk drug use were more likely to consume higher amounts of opioid medications postoperatively. Additionally, surgeons did not incorporate key patient-level factors (eg, substance use, preoperative pain) into opioid prescribing practices. Opportunities to improve postoperative opioid prescribing include system changes among surgical specialties, and patient education and monitoring. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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