Perioperative Prescribing Practices of Extended-Release Opioids in Noncancer Surgical Patients, 2015-2018
| Autor: | Mahim Naveed, Catherine L. Chen, Rosa Rodriguez-Monguio, Erica Langnas, Rhiannon Croci, Enrique Seoane-Vazquez, Kendall Gross |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Adult
Male Pain medicine Narcotic-Related Disorders Anesthesia General Drug Prescriptions Cohort Studies 03 medical and health sciences 0302 clinical medicine 030202 anesthesiology Risk Factors medicine Humans Postoperative Period Elective surgery Practice Patterns Physicians' Perioperative Period Aged Pain Postoperative business.industry Retrospective cohort study Perioperative Analgesics Non-Narcotic Length of Stay Middle Aged medicine.disease Confidence interval Substance abuse Analgesics Opioid Anesthesiology and Pain Medicine Treatment Outcome Opioid Elective Surgical Procedures Anesthesia Delayed-Action Preparations Female business 030217 neurology & neurosurgery Cohort study medicine.drug |
| Zdroj: | Anesthesia and analgesia. 131(4) |
| ISSN: | 1526-7598 |
| Popis: | BACKGROUND Extended-release (ER) opioids are indicated for the management of persistent moderate to severe pain in patients requiring around-the-clock opioid analgesics for an extended period of time. Concerns have been raised regarding safety of ER opioids due to its potential for abuse and dependence. However, little is known about perioperative prescribing practices of ER opioids. This study assessed perioperative prescribing practices of ER opioids in noncancer surgical patients stratified by type of opioid exposure prior to admission and examined predictors of postoperative opioid administration in oral morphine equivalents (OME). METHODS This was a retrospective cohort study using the University of California San Francisco Medical Center electronic health record data. This study included 25,396 adult noncancer patients undergoing elective surgery under general anesthesia in the period 2015-2018. The primary study outcome was predictors of postoperative administration of opioids in hospitalized surgical patients. Secondary outcomes included patients discontinued and initiated on ER opioids during their hospital stay. RESULTS substance use disorder diagnosis and use of opioids, surgery type, and postoperative administration of nonopioid analgesics were associated with postoperative administration of opioids (P < .0001). The estimated adjusted mean (95% confidence interval [CI]) of postoperative administration of OME prior to admission in ER opioid users (170.08 mg; 147.08-196.67) was twice the amount for opioid-naive patients (81.36 mg; 70.7-93.63; P < .0001). One in 5 prior to admission ER opioid users were weaned off ER opioids while hospitalized without adversely affecting their postoperative pain or hospital length of stay (LOS). Four of 5 patients who used ER opioids prior to admission also received ER opioids after surgery, whereas, 1 in 100 opioid-naive patients received ER opioids during their hospital stay. CONCLUSIONS We found significant variability in the perioperative prescribing practices of ER opioids in hospitalized noncancer surgical patients by use of opioids prior to admission and surgery type. Pain medicine practitioners and surgeons may play a significant role tackling the surgery-related risk of exposure to ER opioids and decreasing opioid-related complications. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|