A statewide comparison of opioid prescribing in teaching versus nonteaching hospitals
| Autor: | Michael J. Englesbe, James M. Dupree, Hsou Mei Hu, Jay S. Lee, David C. Cron, Charles Hwang, Kevin C. Chung, Jennifer F. Waljee, John D. Syrjamaki, Chad M. Brummett |
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| Rok vydání: | 2019 |
| Předmět: |
Adult
Male medicine.medical_specialty education Drug Prescriptions Opioid prescribing Article Teaching hospital Humans Medicine Medical prescription Hospitals Teaching Pain Postoperative business.industry Workload Middle Aged Surgical training Multilevel regression Analgesics Opioid Opioid Prescription opioid Emergency medicine Female Surgery business medicine.drug |
| Zdroj: | Surgery. 165:825-831 |
| ISSN: | 0039-6060 |
| DOI: | 10.1016/j.surg.2018.10.005 |
| Popis: | Background Postoperative opioid prescribing is often excessive, but the differences in opioid prescribing between teaching hospitals and nonteaching hospitals is not well understood. Given the workload of surgical training and frequent turnover of prescribers on surgical services, we hypothesized that postoperative opioid prescribing would be higher among teaching compared with nonteaching hospitals. Study design We used insurance claims from a statewide quality collaborative in Michigan to identify 17,075 opioid-naive patients who underwent 22 surgical procedures across 76 hospitals from 2012 to 2016. Our outcomes included the following: (1) the amount of opioid prescribed for the initial postoperative prescription in oral morphine equivalents and (2) high-risk prescribing in the 30 days after surgery (high daily dose [≥ 100 oral morphine equivalents], new long-acting/extended-release opioid, overlapping prescriptions, or concurrent benzodiazepine prescription). Teaching hospital status was obtained from the 2014 American Hospital Association survey. Multilevel regression was used to adjust for patient and procedural factors and to perform reliability adjustment. Results The amount of opioid prescribed per initial opioid prescription varied 4.7-fold across all hospitals from 130 oral morphine equivalents to 616 oral morphine equivalents. Patients discharged from teaching hospitals filled larger initial opioid prescriptions overall compared with nonteaching hospitals (251 oral morphine equivalents versus 232 oral morphine equivalents; P = .026). Teaching hospitals had higher risk-adjusted rates of high-risk prescribing compared with nonteaching hospitals (13.7% vs 10.3%; P = .034). Conclusion In Michigan, surgical patients discharged from teaching hospitals received significantly larger postoperative opioid prescriptions and had higher rates of high-risk prescribing compared with nonteaching hospitals. All hospitals, and particularly teaching institutions, should ensure that adequate resources are devoted to facilitating safe postoperative opioid prescribing. |
| Databáze: | OpenAIRE |
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