What evidence is needed to inform postoperative opioid consumption guidelines? A cohort study of the Michigan Surgical Quality Collaborative.

Autor:	Song J; Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan, USA., Li Y; Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan, USA., Waljee JF; Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA.; Opioid Prescribing Engagement Network, Institute for Health Policy and Innovation, Ann Arbor, MI, USA., Gunaseelan V; Opioid Prescribing Engagement Network, Institute for Health Policy and Innovation, Ann Arbor, MI, USA.; Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA., Brummett CM; Opioid Prescribing Engagement Network, Institute for Health Policy and Innovation, Ann Arbor, MI, USA.; Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA., Englesbe MJ; Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA.; Opioid Prescribing Engagement Network, Institute for Health Policy and Innovation, Ann Arbor, MI, USA., Bicket MC; Opioid Prescribing Engagement Network, Institute for Health Policy and Innovation, Ann Arbor, MI, USA mbicket@med.umich.edu.; Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA.; Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, Michigan, USA.
Jazyk:	angličtina
Zdroj:	Regional anesthesia and pain medicine [Reg Anesth Pain Med] 2024 Jan 11; Vol. 49 (1), pp. 23-29. Date of Electronic Publication: 2024 Jan 11.
DOI:	10.1136/rapm-2023-104581
Abstrakt:	Introduction: To balance adequate pain management while minimizing opioid-related harms after surgery, opioid prescribing guidelines rely on patient-reported use after surgery. However, it is unclear how many patients are required to develop precise guidelines. We aimed to compare patterns of use, required sample size, and the precision for patient-reported opioid consumption after common surgical procedures. Methods: We analyzed procedure-specific 30-day opioid consumption data reported after discharge from 15 common surgical procedures between January 2018 and May 2019 across 65 hospitals in the Michigan Surgical Quality Collaborative. We calculated proportions of patients using no pills and the estimated number of pills meeting most patients' needs, defined as the 75th percentile of consumption. We compared several methods to model consumption patterns. Using the best method (Tweedie), we calculated sample sizes required to identify opioid consumption within a 5-pill interval and estimates of pills to meet most patients' needs by calculating the width of 95% CIs. Results: In a cohort of 10,688 patients, many patients did not consume any opioids after all types of procedures (range 20%-40%). Most patients' needs were met with 4 pills (thyroidectomy) to 13 pills (abdominal hysterectomy). Sample sizes required to estimate opioid consumption within a 5-pill wide 95% CI ranged from 48 for laparoscopic appendectomy to 188 for open colectomy. The 95% CI width for estimates ranged from 0.7 pills for laparoscopic cholecystectomy to 7.0 pills for ileostomy/colostomy. Conclusions: This study demonstrates that profiles of opioid consumption share more similarities than differences for certain surgical procedures. Future investigations on patient-reported consumption are required for procedures not currently included in prescribing guidelines to ensure surgeons and perioperative providers can appropriately tailor recommendations to the postoperative needs of patients. Competing Interests: Competing interests: JS, YL, and VG have no disclosures. CMB, MJE, JFW, and MCB receive funding from the Michigan Department of Health and Human Services and the National Institute on Drug Abuse (R01DA042859). CMB is a consultant for Heron Therapeutics, Vertex Pharmaceuticals, Alosa Health and the Benter Foundation, not related to this work. JS had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. (© American Society of Regional Anesthesia & Pain Medicine 2024. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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