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Malik AT, Lin JS, Jain S, Awan H, Khan SN, Goyal KS. Interspecialty Variation in Perioperative Health Care Resource Usage for Carpal Tunnel Release. Hand (N Y) 2024:15589447241233710. [PMID: 38420784 DOI: 10.1177/15589447241233710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
BACKGROUND We investigated whether any interspecialty variation exists, regarding perioperative health care resource usage, in carpal tunnel releases (CTRs). METHODS The 2010 to 2021 PearlDiver Mariner Database, an all-payer claims database, was queried to identify patients undergoing primary CTRs. Physician specialty IDs were used to identify the specialty of the surgeon-orthopedic versus plastic versus general surgery versus neurosurgery. Multivariate logistic regression analysis was used to identify whether there was any interspecialty variation between the use of health care resources. RESULTS A total of 908 671 patients undergoing CTRs were included, of which 556 339 (61.2%) were by orthopedic surgeons, 297 047 (32.7%) by plastic surgeons, 44 118 (4.9%) by neurosurgeons, and 11 257 (1.2%) by general surgeons. In comparison with orthopedic surgeons, patients treated by plastic surgeons were less likely to have received opioids, nonsteroidal anti-inflammatory drugs, oral steroids, and preoperative antibiotic prophylaxis but were more likely to have received steroid injections and electrodiagnostic studies (EDSs) preoperatively. Patients treated by neurosurgeons were more likely to have received preoperative opioids, gabapentin, oral steroids, preoperative antibiotic prophylaxis, EDSs, and formal preoperative physical/occupational therapy and less likely to have received steroid injections. Patients treated by general surgeons were less likely to receive oral steroids, steroid injections, EDSs, preoperative formal physical therapy, and preoperative antibiotic prophylaxis, but were more likely to be prescribed gabapentin. CONCLUSIONS There exists significant variation in perioperative health care resource usage for CTRs between specialties. Understanding reasons behind such variation would be paramount in minimizing differences in how care is practiced for elective hand procedures.
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Affiliation(s)
| | - James S Lin
- The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Sonu Jain
- The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Hisham Awan
- The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Safdar N Khan
- The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Kanu S Goyal
- The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Shlobin NA, Rosenow JM. Nonopioid Postoperative Pain Management in Neurosurgery. Neurosurg Clin N Am 2022; 33:261-273. [DOI: 10.1016/j.nec.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Beyene KA, Chan AHY, Aquite OM, Kumar M, Moore S, Park YJ, Ruohonen T, Gong J. Postdischarge opioid use and persistent use after general surgery: A retrospective study. Surgery 2022; 172:602-611. [DOI: 10.1016/j.surg.2022.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 02/08/2022] [Accepted: 02/28/2022] [Indexed: 11/28/2022]
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Stanley B, Collins L, Norman A, Bonomo A, Bonomo Y. Reducing opioid prescribing on discharge after orthopaedic surgery: does a guideline and education improve prescribing practice 1 year later? ANZ J Surg 2022; 92:1171-1177. [PMID: 35188322 DOI: 10.1111/ans.17557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 01/18/2022] [Accepted: 01/31/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND An intervention Prescription Opioid Practice Improvement (POPI), addressing opioid prescribing on discharge following orthopaedic surgery, demonstrated improved practice. Here we report the sustainability of improved practice at 12 months, and the impact of a booster education intervention, POPI SOS (Safe Opioid Supply). METHODS Audits were performed using methodology described in previously published studies. RESULTS High proportion of patients were discharged on opioids, 89.9% 12 months post-POPI (n = 149) and 82.2% post-POPI SOS (n = 169). Twelve months post-POPI there was a significant reduction in combination immediate (IR) and slow release (SR) opioids, 45.7% at the end of POPI program to 34.3% at 12 months (χ2 (1, N = 364) = 4.47, ρ = 0.034); a significant decrease in opioid-weaning plans, 87.4% at the end of POPI program to 35.8% at 12 months (χ2 (1, N = 365) = 104.19, ρ = <0.001); and a significant increase in provision of full quantities of SR-opioids, 6.1% after the POPI program to 15.7% (χ2 (1, N = 364) = 8.95, ρ = 0.003). The POPI SOS booster program significantly improved measures including reduction in combination IR and SR, 34.3-22.3% (χ2 (1, N = 273) = 4.87, ρ = 0.028) and an increase in opioid plans in discharge summaries, from 35.8% to 77.7% (χ2 (1, N = 273) = 48.87, ρ < 0.001). CONCLUSION Better practice in relation to opioid prescribing is achievable but, for sustained improvement, opioid stewardship activities are needed to reduce the potential harms associated with prescription opioids.
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Affiliation(s)
- Beata Stanley
- Department of Addiction Medicine, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Lisa Collins
- Department of Addiction Medicine, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Amanda Norman
- Department of Addiction Medicine, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Anthony Bonomo
- Department of Orthopaedics, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Yvonne Bonomo
- Department of Addiction Medicine, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
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Comparison of opioid prescribing upon hospital discharge in patients receiving tapentadol versus oxycodone following orthopaedic surgery. Int J Clin Pharm 2021; 43:1602-1608. [PMID: 34089144 DOI: 10.1007/s11096-021-01290-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 05/27/2021] [Indexed: 10/21/2022]
Abstract
Background The changing of opioids during the transition of care from hospital to home may be associated with harm. Objective To compare patients receiving tapentadol IR versus oxycodone IR following orthopaedic surgery during hospitalisation with regard to the changing of opioids at hospital discharge. Setting A major metropolitan tertiary referral hospital in Australia. Methods This is a retrospective cohort study. Participants included adult orthopaedic surgery patients receiving postoperative tapentadol IR or oxycodone IR during hospitalisation between 1 January 2018 and 30 June 2019. Main outcome measure The proportion of patients for whom the opioid prescribed was changed at hospital discharge. Results The study cohort included 199 patients. Of these, 100 patients received oxycodone and 99 patients received tapentadol post-operatively during hospitalisation. The mean age was 66 years (SD, 12 years) and 111 (56%) were female. The most common surgeries were total knee arthroplasty (91, 46%), total hip arthroplasty (63, 32%) and shoulder surgery (26, 13%). Patients in the tapentadol group were more likely to be changed to a different opioid upon hospital discharge than the oxycodone group (57% versus 9%, difference 48% [95% CI 36-59%, p < 0.01). After adjusting for confounders, post-operative tapentadol use was more likely to be associated with opioid changing upon discharge (OR 16.5, 95% CI 6.7 to 40.8, p < 0.01). Conclusions The post-operative use of tapentadol IR during hospitalisation was associated with an increased likelihood of opioid changing at hospital discharge. This practice could have patient safety implications.
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Harris AB, Zhang B, Marrache M, Puvanesarajah V, Raad M, Hassanzadeh H, Bicket M, Jain A. Chronic Opioid Use Following Lumbar Discectomy: Prevalence, Risk Factors, and Current Trends in the United States. Neurospine 2020; 17:879-887. [PMID: 33401866 PMCID: PMC7788426 DOI: 10.14245/ns.2040122.061] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 05/03/2020] [Indexed: 11/19/2022] Open
Abstract
Objective Lumbar discectomy is commonly performed for symptomatic lumbar disc herniation. We aimed to examine prescribing patterns and risk factors for chronic opioid use following lumbar discectomy.
Methods Using a private insurance claims database, patients were identified who underwent primary lumbar discectomy from 2010–2015 and had 1-year of continuous enrollment postoperatively. Patients were excluded with spinal fusion. The strength of opioid prescriptions was quantified using morphine milligram equivalents daily (MMED). Univariate and multivariate logistic regression models were built to examine risk factors associated with chronic postoperative opioid use.
Results A total of 5,315 patients were included in the study (mean age, 59 years; 50% female). 1,198 of patients (23%) used chronic opioids postoperatively. Chronic opioid use declined significantly from 27% in 2010 to 17% in 2015, p < 0.001. In addition, there were significantly fewer patients receiving high and very high-dose opioid prescriptions from 2010–2015, p < 0.001. The median duration that patients used opioids postoperatively was 211 days in 2010 (interquartile range [IQR], 29–356 days), and decreased significantly to 44 days (IQR, 10–294 days) in 2015. The strongest factors associated with chronic opioid use were preoperative opioid use (odds ratio [OR], 4.0), drug abuse (OR, 2.6), depression (OR, 1.6), surgery in the west (OR, 1.6) or south (OR, 1.6), anxiety (OR, 1.5), or 30-day readmission (OR, 1.4).
Conclusion Chronic opioid use following primary lumbar discectomy has declined from 2010–2015. A variety of factors are associated with chronic opioid use. Preoperative recognition of some of these risk factors may aid in perioperative management and counseling.
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Affiliation(s)
- Andrew B Harris
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Bo Zhang
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Majd Marrache
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Varun Puvanesarajah
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Micheal Raad
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Hamid Hassanzadeh
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| | - Mark Bicket
- Department of Anesthesiology, The Johns Hopkins University, Baltimore, MD, USA.,Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Amit Jain
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
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Kessler BA, Burrus B, Somashekar G, Wurzelmann SP, Bhowmick D. Limitations on Postoperative Opioid Prescriptions and Effects on Health Care Resource Use Following Elective Anterior Cervical Discectomy and Fusion. World Neurosurg 2020; 146:e501-e508. [PMID: 33127575 DOI: 10.1016/j.wneu.2020.10.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 10/21/2020] [Accepted: 10/23/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To curb the misuse of postoperative prescription opioids, the state of North Carolina enacted the Strengthen Opioid Misuse Prevention (STOP) Act of 2017 limiting the duration of initial postoperative opioid prescriptions. The purpose of this study was to evaluate the STOP Act's effect on health care resource use by comparing patient outcomes and opioid prescribing practices following elective anterior cervical discectomy and fusion (ACDF). METHODS Outcomes and opioid prescribing data were retrospectively evaluated for Pre-Law (January 1, 2017, to December 31, 2017) and Post-Law (January 1, 2018, to December 31, 2018) elective 1- to 4-level anterior cervical discectomy and fusion patient cohorts. Outcome measures included hospital and clinic resource use in the form of emergency department visits, readmissions, major postoperative complications, number of clinic visits, or number of clinic phone calls by patients reporting uncontrolled pain or requesting new opioid prescriptions. Opioid-prescribing practices in the form of discharge prescription number of pills and total morphine milliequivalents also were recorded. RESULTS Surrounding the STOP Act's implementation, there was no significant difference (P > 0.05) in emergency department visits, readmissions, major complications, number of postoperative clinic visits, or number of clinic phone calls for uncontrolled pain or new prescription requests. There was a significant decline in mean discharge prescription number of pills (89.7 vs. 67.0, P < 0.001), and average morphine milliequivalents (683.4 vs. 509.6, P < 0.001). CONCLUSIONS This may reflect overprescribing in this population, where larger opioid prescriptions were likely not needed to manage pain that would otherwise require a return to care.
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Affiliation(s)
- Brice A Kessler
- Department of Neurosurgery, University of North Carolina School of Medicine, Durham, North Carolina, USA.
| | - Brainard Burrus
- University of North Carolina School of Medicine, Durham, North Carolina, USA
| | - Greeshma Somashekar
- University of North Carolina School of Medicine, Durham, North Carolina, USA
| | - Samuel P Wurzelmann
- University of North Carolina School of Medicine, Durham, North Carolina, USA
| | - Deb Bhowmick
- Department of Neurosurgery, University of North Carolina School of Medicine, Durham, North Carolina, USA
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Qu LG, Chan G, Gani J. Clinician training level impacts prescribing practices for the conservative management of acute renal colic: a contemporary update. Int Urol Nephrol 2020; 53:661-667. [PMID: 33104951 DOI: 10.1007/s11255-020-02686-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 10/14/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Given the current and increasing awareness of the opioid crisis, this study aimed to characterise the types of analgesic prescription for conservatively managed renal colic. METHODS This was a retrospective cohort study of consecutive patients presenting to the Emergency Department (ED) in 2014-2019. Patients were included if they had radiographically confirmed obstructing calculus, managed conservatively without intervention, and were given a prescription for analgesia on discharge. Patient demographics were recorded and analysed. Opioid, non-opioid, and alpha-blocker medications were compared according to patient and disease parameters, and clinician training. Oral morphine equivalents (OMEs) were used to compare prescribed quantities. Subgroup analyses of stone size and location were performed. RESULTS Our analysis included 1761 patients with confirmed renal colic: median age of 50 years (16-96). Altogether, 88% of included patients were prescribed opioids on discharge, while only 68% were prescribed non-opioids (p < 0.001). Oxycodone immediate release was the most frequently prescribed analgesic. Logistic regression modelling controlling for patient and disease characteristics significantly predicted more non-opioid (p < 0.001) and alpha-blocker (p = 0.037) prescription with clinician training < 3 years. Linear regression modelling demonstrated that clinicians training < 3 years predicted lower OMEs per prescription compared to clinicians with ≥ 3 years of training (p = 0.001). Subgroup analyses supported similar predictions with training. CONCLUSIONS Prescribing patterns are associated with different clinician experience levels. However, a substantial amount of opioids are still given overall on patient discharge regardless of the clinician experience. Educational interventions aimed at reducing the opioid prescription rate and quantities may be considered for clinicians of all training levels.
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Affiliation(s)
- Liang G Qu
- Department of Urology, Austin Health, 145-161 Studley Rd, Heidelberg, VIC, 3084, Australia. .,Department of Surgery, University of Melbourne, Melbourne, VIC, Australia.
| | - Garson Chan
- Department of Urology, Austin Health, 145-161 Studley Rd, Heidelberg, VIC, 3084, Australia.,Department of Surgery, University of Melbourne, Melbourne, VIC, Australia.,Department of Surgery, University of Saskatchewan, Saskatchewan, Canada
| | - Johan Gani
- Department of Urology, Austin Health, 145-161 Studley Rd, Heidelberg, VIC, 3084, Australia.,Department of Surgery, University of Melbourne, Melbourne, VIC, Australia.,Department of Urology, Western Health, Footscray, VIC, Australia
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9
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Risk Factors for Prolonged Opioid Use and Effects of Opioid Tolerance on Clinical Outcomes After Anterior Cervical Discectomy and Fusion Surgery. Spine (Phila Pa 1976) 2020; 45:968-975. [PMID: 32604353 DOI: 10.1097/brs.0000000000003511] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE The aim of this study was to determine risk factors for prolonged opioid use and to investigate whether opioid-tolerance affects patient-reported outcomes following anterior cervical discectomy and fusion (ACDF) surgery. SUMMARY OF BACKGROUND DATA There is a lack of consensus on risk factors that can affect continued opioid use after cervical spine surgery and the influence of opioid use on patient-reported outcomes. METHODS Ninety-two patients who underwent ACDF for degenerative cervical pathologies were retrospectively identified and their opioid usage before surgery was investigated using a state-sponsored prescription drug monitoring registry. Opioid-naïve and opioid tolerant groups were defined using criteria most consistent with the Federal Drug Administration (FDA) definition. Patient-reported outcomes were then collected, including the Short Form-12 (SF-12) Physical Component (PCS-12) and Mental Component (MCS-12), the Neck Disability Index (NDI), the Visual Analogue Scale Neck (VAS neck) and the Visual Analogue Scale Arm (VAS Arm) pain scores. Logistic regression was used to determine predictors for prolonged opioid use following ACDF. Univariate and multivariate analyses were conducted to compare change in outcomes over time between the two groups. RESULTS Logistic regression analysis demonstrated that opioid tolerance was a significant predictor for prolonged opioid use after ACDF (odds ratio [OR]: 18.2 [1.46, 226.4], P = 0.02). Duration of usage was also found to be a significant predictor for continued opioid use after surgery (OR: 1.10 [1.0, 1.03], P = 0.03). No other risk factors were found to be significant predictors. Both groups overall experienced improvements in patient-reported outcomes after surgery. Multiple linear regression analysis, controlling for patient demographics, demonstrated that opioid-tolerant user status positively affected change in outcomes over time for NDI (β = -13.7 [-21.8,-5.55], P = 0.002) and PCS-12 (β = 6.99 [2.59, 11.4], P = 0.003) but no other outcomes measured. CONCLUSION Opioid tolerance was found to be a significant predictor for prolonged opioid use after ACDF. Additionally, opioid-naïve and opioid-tolerant users experienced overall improvements across PROMs following ACDF. Opioid-tolerance was associated with NDI and PCS-12 improvements over time compared to opioid-naïve users. LEVEL OF EVIDENCE 4.
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Tran T, Taylor SE, George J, Pisasale D, Batrouney A, Ngo J, Stanley B, Elliott RA. Evaluation of communication to general practitioners when opioid-naïve post-surgical patients are discharged from hospital on opioids. ANZ J Surg 2020; 90:1019-1024. [PMID: 32338817 DOI: 10.1111/ans.15903] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 03/24/2020] [Accepted: 03/28/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND To address the opioid crisis, much work has focused on minimizing opioid supply to surgical patients upon hospital discharge. Research is limited regarding handover to primary care providers. The aim of this study was to evaluate the communication of post-operative opioid prescribing information provided by hospitals to general practitioners (GPs). METHODS This study comprised two components. First, a retrospective audit of discharge summaries for opioid-naïve surgical patients supplied with an opioid on discharge was conducted to evaluate accuracy of opioid documentation and presence of an opioid management plan. Second, a survey was distributed to GPs to seek their opinions regarding adequacy of communication about hospital-initiated opioids in discharge summaries, challenges experienced in opioid management and suggestions for improvement. RESULTS Discharge summaries for 285 patients were audited. Twenty-seven (9.5%) patients had no discharge summary completed. Of the remaining 258, 63 (24.4%) summaries had at least one discrepancy between the opioid(s) listed and the opioid(s) dispensed. Only 33 (12.8%) summaries contained an opioid management plan. From 57 GP-completed surveys, 41 (71.9%) GPs rarely or never received an opioid management plan from hospital surgical units and 34 (59.7%) were dissatisfied/very dissatisfied with information provided about opioid supply and management. Qualitative responses highlighted difficulties GPs experience managing opioid treatment for post-surgical patients after discharge, differing patient expectations and the need to improve communication at times of transition. CONCLUSION When opioid-naive patients are discharged from hospital on opioids, communication from hospitals to GPs is poor. Future interventions should focus on strategies to improve this.
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Affiliation(s)
- Tim Tran
- Pharmacy Department, Austin Health, Melbourne, Victoria, Australia.,Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Simone E Taylor
- Pharmacy Department, Austin Health, Melbourne, Victoria, Australia
| | - Johnson George
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Daisy Pisasale
- Pharmacy Department, Austin Health, Melbourne, Victoria, Australia
| | - Adele Batrouney
- Pharmacy Department, Austin Health, Melbourne, Victoria, Australia
| | - Janet Ngo
- Pharmacy Department, Austin Health, Melbourne, Victoria, Australia
| | - Beata Stanley
- Department of Addiction Medicine, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Rohan A Elliott
- Pharmacy Department, Austin Health, Melbourne, Victoria, Australia.,Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
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Veal F, Thompson A, Halliday S, Boyles P, Orlikowski C, Bereznicki L. The Persistence of Opioid Use Following Surgical Admission: An Australian Single-Site Retrospective Cohort Study. J Pain Res 2020; 13:703-708. [PMID: 32308469 PMCID: PMC7148161 DOI: 10.2147/jpr.s235764] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 03/07/2020] [Indexed: 11/23/2022] Open
Abstract
Background Acute pain is common following surgery, with opioids frequently employed in its management. Studies indicate that commencing an opioid during a hospital admission increases the likelihood of long-term use. This study aimed to identify the prevalence of opioid persistence amongst opioid-naïve patients following surgery as well as the indication for use. Methods A retrospective review of patients who underwent a surgical procedure at the Royal Hobart Hospital, Tasmania, Australia, between August and September 2016 was undertaken. Patients were linked to the Tasmanian real-time prescription monitoring database to ascertain if they were subsequently dispensed a Schedule 8 opioid (morphine, codeine oxycodone, buprenorphine, hydromorphone, fentanyl, methadone, or tapentadol) and the indication for use. Results Of the 3275 hospital admissions, 1015 opioid-naïve patients were eligible for inclusion. Schedule 8 opioids were dispensed at or within 2 days of discharge in 41.7% of admissions. Thirty-nine (3.9%) patients received prescribed opioids 2-months post-discharge; 1.8% of the patients were approved by State Health to be prescribed Schedule 8 opioids regularly for a chronic condition at 6 months, and 1.3% received infrequent or one-off prescriptions for Schedule 8 opioids at 6 months. Thirteen (1.3%) patients continued Schedule 8 opioids for at least 6 months following their surgery, with the indication for treatment either related to the surgery or the condition which surgery was sought for. Conclusion This study found that there was a low rate of Schedule 8 opioid persistence following surgery, indicating post-surgical pain is not a significant driver for persistent opioid use.
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Affiliation(s)
- Felicity Veal
- Unit for Medication Outcomes Research & Education (UMORE), School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Tasmania, Australia
| | - Angus Thompson
- Unit for Medication Outcomes Research & Education (UMORE), School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Tasmania, Australia
| | | | - Peter Boyles
- Department of Health, Hobart, Tasmania, Australia
| | | | - Luke Bereznicki
- Unit for Medication Outcomes Research & Education (UMORE), School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Tasmania, Australia
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Harris AB, Marrache M, Jami M, Raad M, Puvanesarajah V, Hassanzadeh H, Lee SH, Skolasky R, Bicket M, Jain A. Chronic opioid use following anterior cervical discectomy and fusion surgery for degenerative cervical pathology. Spine J 2020; 20:78-86. [PMID: 31536805 DOI: 10.1016/j.spinee.2019.09.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 09/08/2019] [Accepted: 09/11/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Although prescribing opioid medication on a limited basis for postoperative pain control is common practice, few studies have focused on chronic opioid use following anterior cervical discectomy and fusion (ACDF). PURPOSE To determine the prevalence of and risk factors for chronic opioid use following one and two-level ACDF for degenerative cervical pathology. DESIGN Retrospective cohort. PATIENT SAMPLE Using an insurance claims database, we identified patients aged 18-64 who underwent one or two-level primary ACDF from 2010 to 2015 for degenerative cervical pathology. OUTCOME MEASURES Opioid prescription strength at various timepoints pre- and postoperatively and development of chronic postoperative opioid use. METHODS Prescription opioid use was examined during the following periods: 90 days before 7 days preceding surgery (preoperative), 6 days preceding surgery to 90 days following surgery (perioperative) and from 91 to 365 days following surgery (postoperative). The primary outcome was chronic postoperative opioid use, defined as ≥120 days' supply of opioid prescriptions filled or ≥10 opioid prescriptions between 3 and 12 months postoperatively. Secondary outcomes were high-dose (>90 morphine milligram equivalents [MME]/day) and very high-dose (>200 MME/day) opioid prescriptions. A multivariate logistic model (area under the ROC curve 0.75, p<.001) was built to predict long-term opioid use. RESULTS Among 28,813 patients who underwent ACDF, most were female (55%) and underwent single-level ACDF (68%), with mean age of 50±8.0 years. Fifty-two percent of patients filled an opioid prescription in the preoperative period, 95% of patients filled a prescription in the perioperative period, and 39% of patients filled a prescription in the postoperative period. High-dose and very high-dose opioid prescriptions in the perioperative period were identified in 45% and 24% of patients, respectively, whereas 17% met criteria for chronic postoperative opioid use. The odds of chronic opioid use were highest in the Western US (odds ratio [OR] 1.5, 95% confidence interval [CI] 1.3, 1.6). Duration of opioids prescribed was also highest in the Western US (median 111 days, interquartile range 11-336), p<.001. Factors associated with the highest risk for chronic opioid use were preoperative opioid use (OR 5.7, 95% CI 5.3, 56.2), drug abuse (OR 3.5, 95% CI 2.6, 4.5), depression (OR 1.7, 95% CI 1.6, 1.9), anxiety (OR 1.5, 95% CI 1.4, 1.6), and surgery in the western region of the United States (OR 1.5, 95% CI 1.3, 1.6). CONCLUSIONS Patients undergoing ACDF commonly receive high-dose opioid prescriptions after surgery, and certain patient factors increase risk for chronic opioid use following ACDF. Intervention focusing on patients with these factors is essential to reduce long-term use of prescription opioids and postoperative care.
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Affiliation(s)
- Andrew B Harris
- Department of Orthopedic Surgery, The Johns Hopkins University, 601 N. Caroline St, JHOC 5223, Baltimore, MD 21287, USA
| | - Majd Marrache
- Department of Orthopedic Surgery, The Johns Hopkins University, 601 N. Caroline St, JHOC 5223, Baltimore, MD 21287, USA
| | - Meghana Jami
- Department of Orthopedic Surgery, The Johns Hopkins University, 601 N. Caroline St, JHOC 5223, Baltimore, MD 21287, USA
| | - Micheal Raad
- Department of Orthopedic Surgery, The Johns Hopkins University, 601 N. Caroline St, JHOC 5223, Baltimore, MD 21287, USA
| | - Varun Puvanesarajah
- Department of Orthopedic Surgery, The Johns Hopkins University, 601 N. Caroline St, JHOC 5223, Baltimore, MD 21287, USA
| | - Hamid Hassanzadeh
- Department of Orthopedic Surgery, University of Virginia, Charlottesville, VA, USA
| | - Sang H Lee
- Department of Orthopedic Surgery, The Johns Hopkins University, 601 N. Caroline St, JHOC 5223, Baltimore, MD 21287, USA
| | - Richard Skolasky
- Department of Orthopedic Surgery, The Johns Hopkins University, 601 N. Caroline St, JHOC 5223, Baltimore, MD 21287, USA
| | - Mark Bicket
- Department of Anesthesiology, The Johns Hopkins University, 601 N. Caroline St, JHOC 5223, Baltimore, MD 21287, USA; Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, USA
| | - Amit Jain
- Department of Orthopedic Surgery, The Johns Hopkins University, 601 N. Caroline St, JHOC 5223, Baltimore, MD 21287, USA.
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Stanley B, Jackson A, Norman A, Collins L, Bonomo A, Bonomo Y. Opioid prescribing improvement in orthopaedic specialty unit in a tertiary hospital: a retrospective audit of hospital discharge data pre‐ and post‐intervention for better opioid prescribing practice. ANZ J Surg 2019; 89:1302-1307. [DOI: 10.1111/ans.15305] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 04/24/2019] [Accepted: 04/26/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Beata Stanley
- Department of Addiction MedicineSt Vincent's Hospital Melbourne Melbourne Victoria Australia
| | - Aidan Jackson
- The University of Melbourne Melbourne Victoria Australia
| | - Amanda Norman
- Department of Addiction MedicineSt Vincent's Hospital Melbourne Melbourne Victoria Australia
| | - Lisa Collins
- Department of Addiction MedicineSt Vincent's Hospital Melbourne Melbourne Victoria Australia
| | - Anthony Bonomo
- Department of OrthopaedicsSt Vincent's Hospital Melbourne Melbourne Victoria Australia
| | - Yvonne Bonomo
- Department of Addiction MedicineSt Vincent's Hospital Melbourne Melbourne Victoria Australia
- The University of Melbourne Melbourne Victoria Australia
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14
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Stanley B, Collins LJ, Norman AF, Karro J, Jung M, Bonomo YA. Opioid prescribing in the emergency department of a tertiary hospital: A retrospective audit of hospital discharge data. Emerg Med Australas 2019; 32:33-38. [DOI: 10.1111/1742-6723.13331] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 05/05/2019] [Accepted: 05/14/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Beata Stanley
- Department of Addiction MedicineSt Vincent's Hospital Melbourne Melbourne Victoria Australia
| | - Lisa J Collins
- Department of Addiction MedicineSt Vincent's Hospital Melbourne Melbourne Victoria Australia
| | - Amanda F Norman
- Department of Addiction MedicineSt Vincent's Hospital Melbourne Melbourne Victoria Australia
| | - Jonathon Karro
- Department of Emergency MedicineSt Vincent's Hospital Melbourne Melbourne Victoria Australia
| | - Monica Jung
- Department of Addiction MedicineSt Vincent's Hospital Melbourne Melbourne Victoria Australia
| | - Yvonne A Bonomo
- Department of Addiction MedicineSt Vincent's Hospital Melbourne Melbourne Victoria Australia
- Department of MedicineThe University of Melbourne Melbourne Victoria Australia
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15
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Lim D, Hall A, Jordan M, Suckling B, Tuffin PH, Tynan K, Warrior N, Munro C. Standard of practice in pain management for pharmacy services. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2019. [DOI: 10.1002/jppr.1550] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Daniel Lim
- St Vincent's Hospital Melbourne Victoria Australia
| | - Anthony Hall
- Gold Coast Interprofessional Persistent Pain Centre Robina Australia
- Queensland University of Technology School of Clinical Sciences Faculty of Health Brisbane Australia
| | | | - Benita Suckling
- Redcliffe Hospital Pharmacy Department Metro North Hospital and Health Service Redcliffe Australia
| | | | | | | | - Courtney Munro
- The Society of Hospital Pharmacists of Australia Collingwood Australia
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