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Shin D, Cho HJ, Alaiev D, Tsega S, Talledo J, Zaurova M, Chandra K, Alarcon P, Garcia M, Krouss M. Reducing daily dosing in opioid prescriptions in 11 safety net emergency departments. Am J Emerg Med 2023; 71:63-68. [PMID: 37343340 DOI: 10.1016/j.ajem.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/16/2023] [Accepted: 06/04/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND The United States continues to face a significant issue with opioid misuse, overprescribing, dependency, and overdose. Electronic health record (EHR) interventions have shown to be an effective tool to modify opioid prescribing behaviors. This quality improvement project describes an EHR intervention to reduce daily dosing in opioid prescriptions in 11 emergency departments (ED) across the largest safety net health system in the US. MEASURES The primary outcome measure was the rates of oxycodone-acetaminophen 5-325 mg prescriptions exceeding 50 morphine milligram equivalents per day (MMED) pre- vs. post-intervention; and stratified by individual hospitals and provider type. INTERVENTION The defaults for dose and frequency were uniformly changed to 'every 6 hours as needed' and '1 tablet', respectively, across 11 EDs. OUTCOMES The percentage of prescriptions greater than or equal to 50 MMED decreased from 46.0% (1624 of 3530 prescriptions) to 1.6% (52 of 3165 prescriptions) (96.4% relative reduction; p < 0.001). All 11 hospitals had a significant reduction in prescriptions exceeding 50 MMED. Nurse practitioners had the highest relative reduction of prescriptions exceeding 50 MMED at 100% (p < 0.001), and the attendings/fellows had the lowest relative reduction at 95.6% (p < 0.001). CONCLUSIONS/LESSONS LEARNED Default nudges are a simple yet powerful intervention that can strongly influence opioid prescribing patterns.
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Affiliation(s)
- Dawi Shin
- Icahn School of Medicine, New York, NY, USA; Department of Quality and Safety, NYC Health + Hospitals, New York, NY, USA
| | - Hyung J Cho
- Department of Quality and Safety, Brigham and Women's Hospital, Boston, MA, USA
| | - Daniel Alaiev
- Department of Quality and Safety, NYC Health + Hospitals, New York, NY, USA
| | - Surafel Tsega
- Department of Quality and Safety, NYC Health + Hospitals, New York, NY, USA
| | - Joseph Talledo
- Department of Quality and Safety, NYC Health + Hospitals, New York, NY, USA
| | - Milana Zaurova
- Department of Quality and Safety, NYC Health + Hospitals, New York, NY, USA
| | - Komal Chandra
- Department of Quality and Safety, NYC Health + Hospitals, New York, NY, USA
| | - Peter Alarcon
- Department of Quality and Safety, NYC Health + Hospitals, New York, NY, USA
| | - Mariely Garcia
- Icahn School of Medicine, New York, NY, USA; Department of Quality and Safety, NYC Health + Hospitals, New York, NY, USA
| | - Mona Krouss
- Department of Quality and Safety, NYC Health + Hospitals, New York, NY, USA; Department of Medicine, Icahn School of Medicine, New York, NY, USA.
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Bovonratwet P, Kapadia M, Chen AZ, Vaishnav AS, Song J, Sheha ED, Albert TJ, Gang CH, Qureshi SA. Opioid prescription trends after ambulatory anterior cervical discectomy and fusion. Spine J 2023; 23:448-456. [PMID: 36427653 DOI: 10.1016/j.spinee.2022.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 10/19/2022] [Accepted: 11/07/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND CONTEXT Opioid utilization has been well studied for inpatient anterior cervical discectomy and fusion (ACDF). However, the amount and type of opioids prescribed following ambulatory ACDF and the associated risk of persistent use are largely unknown. PURPOSE To characterize opioid prescription filling following single-level ambulatory ACDF compared with inpatient procedures. STUDY DESIGN/SETTING Retrospective cohort study. PATIENT SAMPLE Opioid-naive patients who underwent ambulatory (no overnight stay) or inpatient single-level ACDF from 2011 to 2019 were identified from a national insurance database. OUTCOME MEASURES Rate, amount, and type of perioperative opioid prescription. METHODS Opioid-naive patients who underwent ambulatory (no overnight stay) or inpatient single-level ACDF from 2011 to 2019 were identified from a national insurance database. Perioperative opioids were defined as opioid prescriptions 30 days before and 14 days after the procedure. Rate, amount, and type of opioid prescription were characterized. Multivariable analyses controlling for any differences in demographics and comorbidities between the two treatment groups were utilized to determine any association between surgical setting and persistent opioid use (defined as the patient still filling new opioid prescriptions >90 days postoperatively). RESULTS A total of 42,521 opioid-naive patients were identified, of which 2,850 were ambulatory and 39,671 were inpatient. Ambulatory ACDF was associated with slightly increased perioperative opioid prescription filling (52.7% vs 47.3% for inpatient procedures; p<.001). Among the 20,280 patients (47.7%) who filled perioperative opioid prescriptions, the average amount of opioids prescribed (in morphine milligram equivalents) was similar between ambulatory and inpatient procedures (550 vs 540, p=.413). There was no association between surgical setting and persistent opioid use in patients who filled a perioperative opioid prescription, even after controlling for comorbidities, (adjusted odds ratio, 1.15, p=.066). CONCLUSIONS Ambulatory ACDF patients who filled perioperative opioid prescriptions were prescribed a similar amount of opioids as those undergoing inpatient procedures. Further, ambulatory ACDF does not appear to be a risk factor for persistent opioid use. These findings are important for patient counseling as well as support the safety profile of this new surgical pathway.
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Affiliation(s)
- Patawut Bovonratwet
- Department of Spine Surgery, Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
| | - Milan Kapadia
- Department of Spine Surgery, Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
| | - Aaron Z Chen
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, 630 W 168th St, New York, NY 10032, USA
| | - Avani S Vaishnav
- Department of Spine Surgery, Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
| | - Junho Song
- Department of Spine Surgery, Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
| | - Evan D Sheha
- Department of Spine Surgery, Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
| | - Todd J Albert
- Department of Spine Surgery, Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
| | - Catherine H Gang
- Department of Spine Surgery, Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
| | - Sheeraz A Qureshi
- Department of Spine Surgery, Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA.
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Walk CT, Nowak R, Parikh PP, Crawford TN, Woods RJ. Perception versus Reality: A Review of Narcotic Prescribing Habits After Common Laparoscopic Surgeries. J Surg Res 2023; 283:188-193. [PMID: 36410235 DOI: 10.1016/j.jss.2022.10.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 10/10/2022] [Accepted: 10/18/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Data on how surgeons perceive their habits of prescribing narcotics compared to their actual practice are scarce. This study examines the perception and actual narcotic prescribing habits of surgeons and advanced practitioners. METHODS Surgical residents, attendings, and advanced practice providers (APPs) were surveyed to assess their perceived prescribing habits at discharge for laparoscopic appendectomy and laparoscopic cholecystectomy. Data on narcotics prescription for patients receiving either of the procedures from January 2017 to August 2020 were extracted from electronic health records. Prescribed narcotics were converted to morphine equivalent doses (MEQs) for comparison. RESULTS Of the 52 participants, the majority were residents (57.7%). Approximately 90% of residents, 72% of attendings, and 18% of APPs reported regularly prescribing narcotics at discharge. Approximately 67% (889/1332) of patients were discharged with narcotics. Of those, the majority of patients' narcotics were prescribed by surgery residents (71.2%). However, 72% of residents, 80% of attendings, and 72% of APPs were confident on prescribing the correct regimen of narcotics. There were no differences in average daily MEQs among the groups. However, the number of narcotics prescribed was higher among APPs compared to that in the other groups (P < 0.0001). CONCLUSIONS Most participants self-reported routinely prescribing narcotics at discharge. Although not the current recommendation, participants felt confident they were prescribing the correct regimen, but were observed to prescribe more than the recommended number of total narcotics which indicates a discrepancy between perception and actual habits of prescribing narcotics. Our findings suggest a need for education in the general surgery residency and continuing medical education setting.
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Affiliation(s)
- Casey T Walk
- Department of Surgery, Wright State University Boonshoft SOM, Dayton, Ohio.
| | - Rebecca Nowak
- Wright State University Boonshoft School of Medicine, Fairborn, Ohio
| | - Priti P Parikh
- Department of Surgery, Wright State University Boonshoft SOM, Dayton, Ohio
| | | | - Randy J Woods
- Department of Surgery, Wright State University Boonshoft SOM, Dayton, Ohio
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Hartzell SYT, Keller MS, Albertson EM, Liu Y, Larson M, Friedman S. Variation in Nevada primary care clinicians' use of urine drug testing to mitigate opioid harm. J Subst Use Addict Treat 2023; 145:208940. [PMID: 36880912 DOI: 10.1016/j.josat.2022.208940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 10/11/2022] [Accepted: 12/30/2022] [Indexed: 05/23/2023]
Abstract
INTRODUCTION The prescription opioid epidemic led to federal, state, and health system guidelines and policies aimed at mitigating opioid misuse, including presumptive urine drug testing (UDT). This study identifies whether a difference exists in UDT use among different primary care medical license types. METHODS The study used January 2017-April 2018 Nevada Medicaid pharmacy and professional claims data to examine presumptive UDTs. We examined correlations between UDTs and clinician characteristics (medical license type, urban/rural status, care setting) along with clinician-level measures of patient mix characteristics (proportions of patients with behavioral health diagnoses, early refills). Adjusted odds ratios (AORs) and predicted probabilities (PPs) from a logistic regression with a binomial distribution are reported. The analysis included 677 primary care clinicians (medical doctors [MD], physician assistants [PA], nurse practitioners [NP]). RESULTS Of those in the study, 85.1 % of clinicians did not order any presumptive UDTs. NPs had the highest proportion of UDT use (21.2 % of NPs), followed by PAs (20.0 % of PAs), and MDs (11.4 % of MDs). Adjusted analyses showed that being a PA or NP was associated with higher odds of UDT (PA: AOR: 3.6; 95 % CI: 3.1-4.1; NP: AOR: 2.5; 95 % CI: 2.2-2.8) compared to being an MD. PAs had the highest PP for ordering UDTs (2.1 %, 95 % CI: 0.5 %-8.4 %). Among clinicians who ordered UDTs, midlevel clinicians had higher mean and median UDT use (PA and NP mean: 24.3 % vs. MDs: 19.4 %; PA and NP median: 17.7 % vs. MDs: 12.5 %). CONCLUSION In Nevada Medicaid, UDTs are concentrated among 15 % of primary care clinicians who are frequently non-MDs. More research should include PAs and NPs when examining clinician variation in mitigating opioid misuse.
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Affiliation(s)
- Sarah Y T Hartzell
- School of Public Health, University of Nevada, Reno, 1664 N. Virginia St., Reno, NV 89557, United States.
| | - Michelle S Keller
- Division of General Internal Medicine, Department of Medicine, Cedars-Sinai Medical Center, 8700 Beverly Blvd #2900A, Los Angeles, CA 90040, United States; Department of Health Policy and Management, UCLA Fielding School of Public Health, 650 Charles E Young Dr S, Los Angeles, CA 90095, United States
| | - Elaine Michelle Albertson
- Department of Health Policy and Management, UCLA Fielding School of Public Health, 650 Charles E Young Dr S, Los Angeles, CA 90095, United States
| | - Yan Liu
- School of Public Health, University of Nevada, Reno, 1664 N. Virginia St., Reno, NV 89557, United States
| | - Madalyn Larson
- School of Public Health, University of Nevada, Reno, 1664 N. Virginia St., Reno, NV 89557, United States
| | - Sarah Friedman
- School of Public Health, University of Nevada, Reno, 1664 N. Virginia St., Reno, NV 89557, United States
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Poirrier JE, DeMartino JK, Nagar S, Carrico J, Hicks K, Meyers J, Stoddard J. Burden of opioid use for pain management among adult herpes zoster patients in the US and the potential impact of vaccination. Hum Vaccin Immunother 2022; 18:2040328. [PMID: 35363119 PMCID: PMC9225310 DOI: 10.1080/21645515.2022.2040328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The goal of this research was to describe treatment patterns, health-care resource utilization, and costs for herpes zoster (HZ)-related pain, and to estimate the potential impact of recombinant zoster vaccine (RZV) on avoided HZ cases and HZ-related pain prescriptions. This retrospective claims database study included patients from commercial, Medicare, and Medicaid plans between 2012 and 2017. Subjects with an HZ episode were assigned to three cohorts: “opioid”, “non-opioid”, and “no-treatment” cohorts. Subjects in the opioid cohort were matched to a non-HZ cohort. The potential impact of RZV vaccination on HZ case avoidance and resulting painkiller prescriptions was modeled. Over 25% of subjects with an HZ episode received opioids. Adjusted health-care costs were approximately double in the opioid cohort versus non-opioid or matched non-HZ cohorts. Postherpetic neuralgia, immunocompromised status, and comorbidities increased the risk for opioid prescription. RZV vaccination was predicted to avoid over 19,000 patients from receiving opioid prescriptions for every 1 million adults aged ≥50 years. HZ-related prescriptions of opioids were common and led to increased health care costs. RZV vaccination may potentially reduce opioid prescriptions through decreasing HZ incidence. PLAIN LANGUAGE SUMMARY What is the context? Herpes zoster or shingles and its complications such as postherpetic neuralgia – a painful condition that affects the nerve fibers and skin – may lead to complex pain that can be addressed using opioids in some patients. The recombinant zoster vaccine (RZV) vaccine prevents shingles and, therefore, may reduce the use of opioids and the negative health outcomes and costs associated with it.
What is new? In this retrospective medical claims study, including patients between 2012 and 2017, we
evaluated the receipt of pain medication including opioids in herpes zoster patients, and assessed factors associated with opioid prescription. estimated health care resource utilization and costs associated with opioid use among patients with herpes zoster. assessed the impact of vaccination on opioid prescriptions.
Among subjects receiving opioids, 78.5% started with a weak opioid dose. Dose escalation was uncommon. Postherpetic neuralgia, immunocompromised status, and comorbidities are the main risk factors associated with opioid prescription. Health care costs are almost double in patients with herpes zoster receiving opioids compared with patients without an opioid prescription. In a population of 1 million adults aged 50 years or older, vaccination with the recombinant zoster vaccine could prevent over 19,000 patients from receiving opioids.
What is the impact? Prevention of herpes zoster through vaccination may be a highly effective strategy to reduce opioid prescriptions and costs related to pain management in a susceptible population. Increasing RZV vaccination coverage in adults aged ≥50 years may further reduce potential opioid prescriptions through a decrease in shingles incidence.
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Affiliation(s)
| | | | - Saurabh Nagar
- RTI Health Solutions, Health Economics, Research Triangle Park, NC, USA
| | - Justin Carrico
- RTI Health Solutions, Health Economics, Research Triangle Park, NC, USA
| | - Katherine Hicks
- RTI Health Solutions, Health Economics, Research Triangle Park, NC, USA
| | - Juliana Meyers
- RTI Health Solutions, Health Economics, Research Triangle Park, NC, USA
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Amin-Esmaeili M, Gribble A, Johnson RM, Alinsky RH, Oyedele N, Parnham T, Byregowda H, Schneider KE, Park JN, Goddard L, Susukida R. Unsolicited reporting notifications (URNs) through Maryland's prescription drug monitoring program (PDMP): Characteristics of providers. Drug Alcohol Depend Rep 2022; 5:100111. [PMID: 36844159 PMCID: PMC9948924 DOI: 10.1016/j.dadr.2022.100111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/27/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022]
Abstract
Objectives Unsolicited reporting is the activity of analyzing Prescription Drug Monitoring Program (PDMP) data and then sending unsolicited reporting notifications (URNs) to prescribers to notify them of their outlier prescribing behavior. We aimed to describe information about prescribers who were issued URNs. Methods A retrospective study of Maryland's PDMP data from Jan.2018-Apr.2021. All providers who were issued ≥ one URN were included in analyses. We summarized data on types of URNs issued by provider type and years in practice using basic descriptive measures. We also performed logistic regression analysis to provide odds ratio and estimated marginal probability of issuing ≥ one URN to providers in the Maryland health care workforce in comparison with physicians as reference group. Results A total of 4,446 URNs were issued to 2,750 unique providers. Odds ratio (OR) and the population estimated probability of issuing URNs were higher among nurse practitioners [OR: 1.42, 95% Confidence Interval (CI): 1.26-1.59] followed by physician assistants [OR: 1.87, 95% CI: 1.69-2.08], compared to physicians. Physicians and dentists with >10 years in practice comprised the majority of providers who were issued URNs (65.1% and 62.6%, respectively), while majority of nurse practitioners had been in practice for <10 years (75.8%). Conclusion Findings indicate a higher probability of issuing URN for Maryland's physician assistants and nurse practitioners, compared to physicians, and an overrepresentation of physicians and dentists with longer and nurse practitioners with shorter practice experience. The study suggests education programs on safer prescribing practices and management of opioids should target certain types of providers.
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Affiliation(s)
- Masoumeh Amin-Esmaeili
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University,Corresponding author at: Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, 624 N. Broadway Room 763, Baltimore, MD 21205, United States
| | - Anna Gribble
- Maryland Department of Health (MDH), Office of Provider Engagement and Regulation (OPER)
| | - Renee M. Johnson
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University
| | - Rachel H Alinsky
- Division of Adolescent/Young Adult Medicine, Johns Hopkins University School of Medicine
| | - Natasha Oyedele
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University
| | - Taylor Parnham
- Department of Health Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University
| | - Himani Byregowda
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University
| | - Kristin E. Schneider
- Department of Health Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University
| | | | - Lindsey Goddard
- Maryland Department of Health (MDH), Office of Provider Engagement and Regulation (OPER)
| | - Ryoko Susukida
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University
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Yen HK, Ogink PT, Huang CC, Groot OQ, Su CC, Chen SF, Chen CW, Karhade AV, Peng KP, Lin WH, Chiang H, Yang JJ, Dai SH, Yen MH, Verlaan JJ, Schwab JH, Wong TH, Yang SH, Hu MH. A machine learning algorithm for predicting prolonged postoperative opioid prescription after lumbar disc herniation surgery. An external validation study using 1,316 patients from a Taiwanese cohort. Spine J 2022; 22:1119-30. [PMID: 35202784 DOI: 10.1016/j.spinee.2022.02.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 01/31/2022] [Accepted: 02/14/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Preoperative prediction of prolonged postoperative opioid prescription helps identify patients for increased surveillance after surgery. The SORG machine learning model has been developed and successfully tested using 5,413 patients from the United States (US) to predict the risk of prolonged opioid prescription after surgery for lumbar disc herniation. However, external validation is an often-overlooked element in the process of incorporating prediction models in current clinical practice. This cannot be stressed enough in prediction models where medicolegal and cultural differences may play a major role. PURPOSE The authors aimed to investigate the generalizability of the US citizens prediction model SORG to a Taiwanese patient cohort. STUDY DESIGN Retrospective study at a large academic medical center in Taiwan. PATIENT SAMPLE Of 1,316 patients who were 20 years or older undergoing initial operative management for lumbar disc herniation between 2010 and 2018. OUTCOME MEASURES The primary outcome of interest was prolonged opioid prescription defined as continuing opioid prescription to at least 90 to 180 days after the first surgery for lumbar disc herniation at our institution. METHODS Baseline characteristics were compared between the external validation cohort and the original developmental cohorts. Discrimination (area under the receiver operating characteristic curve and the area under the precision-recall curve), calibration, overall performance (Brier score), and decision curve analysis were used to assess the performance of the SORG ML algorithm in the validation cohort. This study had no funding source or conflict of interests. RESULTS Overall, 1,316 patients were identified with sustained postoperative opioid prescription in 41 (3.1%) patients. The validation cohort differed from the development cohort on several variables including 93% of Taiwanese patients receiving NSAIDS preoperatively compared with 22% of US citizens patients, while 30% of Taiwanese patients received opioids versus 25% in the US. Despite these differences, the SORG prediction model retained good discrimination (area under the receiver operating characteristic curve of 0.76 and the area under the precision-recall curve of 0.33) and good overall performance (Brier score of 0.028 compared with null model Brier score of 0.030) while somewhat overestimating the chance of prolonged opioid use (calibration slope of 1.07 and calibration intercept of -0.87). Decision-curve analysis showed the SORG model was suitable for clinical use. CONCLUSIONS Despite differences at baseline and a very strict opioid policy, the SORG algorithm for prolonged opioid use after surgery for lumbar disc herniation has good discriminative abilities and good overall performance in a Han Chinese patient group in Taiwan. This freely available digital application can be used to identify high-risk patients and tailor prevention policies for these patients that may mitigate the long-term adverse consequence of opioid dependence: https://sorg-apps.shinyapps.io/lumbardiscopioid/.
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Dias J, Zaveri S, Divino C. Postoperative opioid prescribing patterns in the geriatric patient population. Am J Surg 2021; 224:418-422. [PMID: 34974887 DOI: 10.1016/j.amjsurg.2021.12.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/15/2021] [Accepted: 12/21/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Opioid prescription patterns in elderly patients undergoing general surgery are not well characterized. The purpose of this study was to identify trends in postoperative opioid prescriptions in geriatric patients undergoing general surgery procedures and determine prescribing differences between the geriatric and non-geriatric patient population. METHODS We retrospectively evaluated geriatric and non-geriatric patients undergoing the most frequently performed open and laparoscopic general surgery procedures at our institution from 2014 to 2019. Differences in opioid prescriptions between the groups were analyzed. RESULTS We identified 5874 non-geriatric and 3306 geriatrics patients who underwent the included procedures at our institution. 5169 (88.0%) of non-geriatric patients and 2692 (81.4%) of geriatric patients received a perioperative opioid prescription. While the vast majority of both groups were prescribed opioids, geriatric patients were less likely to receive an opioid prescription (p < 0.0001). Between 2016 and 2019, the amount of opioid prescribed in the geriatric population decreased each year (p < 0.0001). Prescription amounts were significantly higher in geriatric patients aged 65-74 compared to patients 85 or older (p < 0.0001). CONCLUSIONS Individuals older than 65 years of age represent a growing percent of the population and there is a need to better understand opioid prescribing practices in this complex patient group. Postoperative opioid prescribing patterns differ significantly between the geriatric and non-geriatric patient population and warrant further investigation.
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Affiliation(s)
- Jennifer Dias
- Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Shruti Zaveri
- Department of Surgery, The Mount Sinai Hospital, New York, NY, USA.
| | - Celia Divino
- Department of Surgery, The Mount Sinai Hospital, New York, NY, USA.
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Asmaro K, Fadel HA, Haider SA, Pawloski J, Telemi E, Mansour TR, Chandra A, Bazydlo M, Robin AM, Lee IY, Air EL, Rock JP, Kalkanis SN, Schwalb JM. Reducing Superfluous Opioid Prescribing Practices After Brain Surgery: It Is Time to Talk About Drugs. Neurosurgery 2021; 89:70-76. [PMID: 33862632 DOI: 10.1093/neuros/nyab061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 01/03/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Opioids are prescribed routinely after cranial surgery despite a paucity of evidence regarding the optimal quantity needed. Overprescribing may adversely contribute to opioid abuse, chronic use, and diversion. OBJECTIVE To evaluate the effectiveness of a system-wide campaign to reduce opioid prescribing excess while maintaining adequate analgesia. METHODS A retrospective cohort study of patients undergoing a craniotomy for tumor resection with home disposition before and after a 2-mo educational intervention was completed. The educational initiative was composed of directed didactic seminars targeting senior staff, residents, and advanced practice providers. Opioid prescribing patterns were then assessed for patients discharged before and after the intervention period. RESULTS A total of 203 patients were discharged home following a craniotomy for tumor resection during the study period: 98 who underwent surgery prior to the educational interventions compared to 105 patients treated post-intervention. Following a 2-mo educational period, the quantity of opioids prescribed decreased by 52% (median morphine milligram equivalent per day [interquartile range], 32.1 [16.1, 64.3] vs 15.4 [0, 32.9], P < .001). Refill requests also decreased by 56% (17% vs 8%, P = .027) despite both groups having similar baseline characteristics. There was no increase in pain scores at outpatient follow-up (1.23 vs 0.85, P = .105). CONCLUSION A dramatic reduction in opioids prescribed was achieved without affecting refill requests, patient satisfaction, or perceived analgesia. The use of targeted didactic education to safely improve opioid prescribing following intracranial surgery uniquely highlights the ability of simple, evidence-based interventions to impact clinical decision making, lessen potential patient harm, and address national public health concerns.
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Affiliation(s)
- Karam Asmaro
- Department of Neurosurgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Hassan A Fadel
- Department of Neurosurgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Sameah A Haider
- Department of Neurosurgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Jacob Pawloski
- Department of Neurosurgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Edvin Telemi
- Department of Neurosurgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Tarek R Mansour
- Department of Neurosurgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Ankush Chandra
- Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Michael Bazydlo
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan, USA
| | - Adam M Robin
- Department of Neurosurgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Ian Y Lee
- Department of Neurosurgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Ellen L Air
- Department of Neurosurgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Jack P Rock
- Department of Neurosurgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Steven N Kalkanis
- Department of Neurosurgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Jason M Schwalb
- Department of Neurosurgery, Henry Ford Health System, Detroit, Michigan, USA
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Delamerced A, Zonfrillo MR, Monteiro K, Watson-Smith D, Wills HE. Factors affecting opioid management for injured children after hospital discharge. J Pediatr Surg 2021; 56:506-511. [PMID: 33246575 DOI: 10.1016/j.jpedsurg.2020.10.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 10/08/2020] [Accepted: 10/15/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Prescription opioid misuse is a national crisis. Injured children often receive opioid medication at hospital discharge, but the role these prescriptions play in the opioid crisis has not been fully elucidated. Whether these opioids are administered, the duration of severe pain requiring opioids, and what the final disposition of unused opioids is in this population remain unknown. METHODS A survey of parent/guardian perceptions of their child's pain after injury, duration of opioid administration, opioid storage and disposal, and perceptions of opioid education was designed. During a 12-month period, parents of injured children admitted to an ACS Level 1 Pediatric Trauma Center were prospectively enrolled by convenience sample. Surveys were in two steps with an enrollment survey prior to discharge and a follow-up survey 7-10 days after discharge. RESULTS Seventy of 114 (61.4%) enrolled parents/guardians completed follow-up survey. Of the 79.1% that reported an opioid prescription for their child, 92.5% filled it. Of those reporting on opioid usage, 10.4% never used the opioid, 75% used opioids <3 days, 12.5% 4-7 days, 2% >7 days. Of those who filled the opioid prescription, 83.7% reported having leftover doses. Reasons for discontinuing opioids included the child no longer had pain (87.2%), the child ran out of medication (5.1%), other (7.7%). Regarding storage, 53.3% reported utilizing an unlocked bathroom cabinet, and 81.3% unlocked kitchen space. Of those reporting unused opioids, 83.3% reported not disposing them, and 38.2% reported no plan for disposal. CONCLUSION The majority of parents/guardians of injured children report resolution of severe pain requiring opioids within 72 h of hospital discharge, and virtually all by 7 days. The majority of injured children were prescribed a greater number of doses than they needed to treat their pain. Many parents/guardians store opioids in unsecure locations and a significant proportion report no plan to dispose of unused opioid doses. Further investigation is warranted to quantify and address the gap between pain control needs and opioid prescribing practices. The rate of unsecure storage and plan to retain unused opioids are potential targets for discharge opioid education. TYPE OF STUDY Cross-sectional survey. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Anna Delamerced
- Primary Care-Population Medicine Program, Alpert Medical School of Brown University, 222 Richmond St, Providence, RI, USA 02903
| | - Mark R Zonfrillo
- Departments of Emergency Medicine and Pediatrics, Alpert Medical School of Brown University, 222 Richmond St, Providence, RI, USA 02903
| | - Kristina Monteiro
- Office of Medical Education and Continuous Quality Improvement, Alpert Medical School of Brown University, 222 Richmond St, Providence, RI, USA 02903
| | - Debra Watson-Smith
- Division of Pediatric Surgery, Hasbro Children's Hospital, 593 Eddy Street, Providence, RI 02905
| | - Hale E Wills
- Division of Pediatric Surgery, Hasbro Children's Hospital, 593 Eddy Street, Providence, RI 02905; Department of Surgery, Alpert Medical School of Brown University, 222 Richmond St, Providence, RI, USA 02903.
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Samuel D, Nevadunsky NS, Miller DT, Isani S, Kuo DYS, Gressel GM. Opioid prescription by gynecologic oncologists: An analysis of Medicare Part D claims. Curr Probl Cancer 2020; 45:100655. [PMID: 32994074 DOI: 10.1016/j.currproblcancer.2020.100655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 08/28/2020] [Indexed: 11/27/2022]
Abstract
The use of opioids across all specialties has increased greatly over the last 2 decades and along with it, opioid misuse, overdose and death. The contribution of opioids prescribed for gynecologic cancers to this problem is unknown. Data from other surgical specialties show prescriber factors including gender, geographic location, board certification, experience, and fellowship training influence opioid prescribing. To characterize national-level opioid prescription patterns among gynecologic oncologists treating Medicare beneficiaries. The Centers for Medicare and Medicaid Services database was used to access Medicare Part D opioid claims prescribed by gynecologic oncologists in 2016. Prescription and prescriber characteristics were recorded including medication type, prescription length, number of claims, and total day supply. Region of practice was determined according to the US Census Bureau Regions. Board certification data were obtained from American Board of Obstetrics and Gynecology website. Bivariate statistical analysis and linear regression modeling were performed using Stata version 14.2. In 2016, 494 board-certified US gynecologic oncologists wrote 24,716 opioid prescriptions for a total 267,824 days of treatment (median 8 [interquartile range {IQR} 6, 11] prescribed days per claim). Gynecologic oncologists had a median of 33 opioid claims (IQR 18, 64). Male physicians had significantly more opioid prescription claims than females (P < 0.01) including after adjustment for differences in years of experience. There was no difference in prescribed days per claim between male and female physicians. Physicians in the South had the greatest number of opioid prescription claims and significantly more than physicians in all other regions (P < 0.01). Gynecologic oncologists who were board certified for >15 years had a greater number of median opioid claims (28 IQR 16, 50) than those with <5 years since board certification (22 IQR 15, 38) (P= 0.04). Physicians who were board certified in palliative care (n = 19) had significantly more opioids claims (median 40; IQR 18, 91) than those without (median 32; IQR 18, 64) (P< 0.01). In 2016, there were gender-based, regional, and experience-related variations in opioid prescribing by providers caring for Medicare-insured patients.
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Affiliation(s)
- David Samuel
- Department of Obstetrics & Gynecology and Women's Health, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA.
| | - Nicole S Nevadunsky
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology and Women's Health, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA; Albert Einstein Cancer Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Devin T Miller
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology and Women's Health, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Sara Isani
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology and Women's Health, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA; Albert Einstein Cancer Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Dennis Y S Kuo
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology and Women's Health, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA; Albert Einstein Cancer Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Gregory M Gressel
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology and Women's Health, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA; Albert Einstein Cancer Center, Albert Einstein College of Medicine, Bronx, New York, USA
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López-Martínez AE, Reyes-Pérez Á, Serrano-Ibáñez ER, Esteve R, Ramírez-Maestre C. Chronic pain, posttraumatic stress disorder, and opioid intake: A systematic review. World J Clin Cases 2019; 7:4254-4269. [PMID: 31911906 PMCID: PMC6940350 DOI: 10.12998/wjcc.v7.i24.4254] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 10/17/2019] [Accepted: 11/26/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The literature suggests that there is a high degree of co-occurrence between chronic pain and posttraumatic stress disorder (PTSD). An association has been found between PTSD and substance abuse. PTSD is a severe disorder that should be taken into account when opioids are prescribed. It has been found that the prevalence of opioid use disorder (OUD) in chronic pain patients is higher among those with PTSD than those without this disorder.
AIM To perform a systematic review on the association between PTSD, chronic non-cancer pain (CNCP), and opioid intake (i.e., prescription, misuse, and abuse).
METHODS We conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The Patient, Intervention, Comparator, and Outcomes (PICOS) criteria were formulated a priori in the protocol of the systematic review. A search was conducted of the PROSPERO database. In March 2019, searches were also conducted of 5 other databases: PubMed, MEDLINE, PsycINFO, Web of Science, and PILOTS. The Scottish Intercollegiate Guidelines Network checklist for cohort studies was used to assess the selected studies for their methodological quality and risk of bias. Each study was evaluated according to its internal validity, participant sampling, confounding variables, and the statistical analysis.
RESULTS A total of 151 potentially eligible studies were identified of which 17 were retained for analysis. Only 10 met the selection criteria. All the studies were published between 2008 and 2018 and were conducted in the United States. The eligible studies included a total of 1622785 unique participants. Of these, 196516 had comorbid CNCP and PTSD and were consuming opiates. The participants had a cross-study mean age of 35.2 years. The majority of participants were men (81.6%). The most common chronic pain condition was musculoskeletal pain: back pain (47.14% across studies; range: 16%-60.6%), arthritis and joint pain (31.1%; range: 18%-67.5%), and neck pain (28.7%; range: 3.6%-63%). In total, 42.4% of the participants across studies had a diagnosis of PTSD (range: 4.7%-95%). In relation to opioid intake, we identified 2 different outcomes: opioid prescription and OUD. All the studies reported evidence of a greater prevalence of PTSD in CNCP patients who were receiving prescribed opioids and that PTSD was associated with OUD in CNCP patients.
CONCLUSION Opioid analgesic prescription as the treatment of choice for CNCP patients should include screening for baseline PTSD to ensure that these drugs are safely consumed.
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Affiliation(s)
- Alicia E López-Martínez
- Facultad de Psicología, Instituto de Investigaciones Biomédicas (IBIMA), Universidad de Málaga, Málaga 29071, Spain
| | - Ángela Reyes-Pérez
- Facultad de Psicología, Instituto de Investigaciones Biomédicas (IBIMA), Universidad de Málaga, Málaga 29071, Spain
| | - Elena Rocío Serrano-Ibáñez
- Facultad de Psicología, Instituto de Investigaciones Biomédicas (IBIMA), Universidad de Málaga, Málaga 29071, Spain
| | - Rosa Esteve
- Facultad de Psicología, Instituto de Investigaciones Biomédicas (IBIMA), Universidad de Málaga, Málaga 29071, Spain
| | - Carmen Ramírez-Maestre
- Facultad de Psicología, Instituto de Investigaciones Biomédicas (IBIMA), Universidad de Málaga, Málaga 29071, Spain
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Morris MC, Marco M, Bailey B, Ruiz E, Im W, Goodin B. Opioid prescription rates and risk for substantiated child abuse and neglect: A Bayesian spatiotemporal analysis. Drug Alcohol Depend 2019; 205:107623. [PMID: 31698321 PMCID: PMC6893092 DOI: 10.1016/j.drugalcdep.2019.107623] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 08/29/2019] [Accepted: 09/01/2019] [Indexed: 02/08/2023]
Abstract
OBJECTIVES To determine the association between opioid prescribing rates and substantiated abuse and neglect across Tennessee counties during an 11-year period. METHODS We adopted a Bayesian spatiotemporal approach to determine the association between opioid prescribing and rates of substantiated child abuse and neglect over and above environmental and population-level covariates. Annual county-level data for Tennessee (2006-2016) included rates of substantiated child abuse and neglect, rates of drug and non-drug crime incidents, racial and Hispanic composition, per capita income, child poverty and teen birth rates, and vacant housing. RESULTS Higher opioid prescribing rates were associated with greater risk for substantiated child abuse and neglect across Tennessee counties. Risk for substantiated child abuse and neglect was positively associated with vacant housing, child poverty, teen birth rates, and rates of both drug and non-drug criminal incidents - including stimulant arrests. Risk for substantiated child abuse and neglect was negatively associated with percentages of African Americans. CONCLUSIONS Results underscore the importance of opioid prescribing and crime rates as independent determinants of spatial and temporal variation in risk for substantiated child abuse and neglect. Policies that regulate and reduce opioid prescribing have the potential to reduce risk for child abuse and neglect.
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Affiliation(s)
- Matthew C. Morris
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Miriam Marco
- Department of Social Psychology and Methodology, Autonomous University of Madrid, Madrid, Spain
| | - Brooklynn Bailey
- Department of Psychology, The Ohio State University, Columbus, Ohio, USA
| | - Ernesto Ruiz
- Department of Family and Community Medicine, Meharry Medical College, Nashville, Tennessee, USA
| | - Wansoo Im
- Department of Family and Community Medicine, Meharry Medical College, Nashville, Tennessee, USA
| | - Burel Goodin
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Shi Y, Liang D, Bao Y, An R, Wallace MS, Grant I. Recreational marijuana legalization and prescription opioids received by Medicaid enrollees. Drug Alcohol Depend 2019; 194:13-19. [PMID: 30390550 PMCID: PMC6318121 DOI: 10.1016/j.drugalcdep.2018.09.016] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 09/19/2018] [Accepted: 09/24/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES Medical marijuana use may substitute prescription opioid use, whereas nonmedical marijuana use may be a risk factor of prescription opioid misuse. This study examined the associations between recreational marijuana legalization and prescription opioids received by Medicaid enrollees. METHODS State-level quarterly prescription drug utilization records for Medicaid enrollees during 2010-2017 were obtained from Medicaid State Drug Utilization Data. The primary outcome, opioid prescriptions received, was measured in three population-adjusted variables: number of opioid prescriptions, total doses of opioid prescriptions in morphine milligram equivalents, and related Medicaid spending, per quarter per 100 enrollees. Two difference-in-difference models were used to test the associations: eight states and DC that legalized recreational marijuana during the study period were first compared among themselves, then compared to six states with medical marijuana legalized before the study period. Schedule II and III opioids were analyzed separately. RESULTS In models comparing eight states and DC, legalization was not associated with Schedule II opioid outcomes; having recreational marijuana legalization effective in 2015 was associated with reductions in number of prescriptions, total doses, and spending of Schedule III opioids by 32% (95% CI: (-49%, -15%), p = 0.003), 30% ((-55%, -4.4%), p = 0.027), and 31% ((-59%, -3.6%), p = 0.031), respectively. In models comparing eight states and DC to six states with medical marijuana legalization, recreational marijuana legalization was not associated with any opioid outcome. CONCLUSIONS No evidence suggested that recreational marijuana legalization increased prescription opioids received by Medicaid enrollees. There was some evidence in some states for reduced Schedule III opioids following the legalization.
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Affiliation(s)
- Yuyan Shi
- Department of Family Medicine and Public Health, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA.
| | - Di Liang
- Department of Family Medicine and Public Health, University of California San Diego, 9500 Gilman Dr, La Jolla, CA 92093, USA
| | - Yuhua Bao
- Department of Healthcare Policy and Research, Weill Cornell Medical College, 425 E 61st St., New York, NY 10065, USA
| | - Ruopeng An
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, 1206 S 4th St, Champaign, IL 61820, USA
| | - Mark S. Wallace
- Department of Anesthesiology, University of California San Diego, 9500 Gilman Dr, La Jolla, CA 92093, USA
| | - Igor Grant
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, CA 92093, USA
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Rubenstein W, Grace T, Croci R, Ward D. The interaction of depression and prior opioid use on pain and opioid requirements after total joint arthroplasty. Arthroplast Today 2018; 4:464-469. [PMID: 30560177 PMCID: PMC6287236 DOI: 10.1016/j.artd.2018.07.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 07/03/2018] [Accepted: 07/04/2018] [Indexed: 11/24/2022] Open
Abstract
Background Preoperative opioid use causes increased pain and opioid requirements after total joint arthroplasty (TJA), but the effect of depression on this relationship is not well defined. Methods We conducted a retrospective review of primary TJA patients using an institutional database. Demographic variables, inpatient opioid requirements, and discharge prescription quantities were collected and compared between patients with and without a prior diagnosis of depression in both the prior opioid-using and nonusing cohorts. Results Four hundred and three patients were analyzed between August 1, 2016, and July 31, 2017. Among prior opioid users, patients with depression experienced higher inpatient pain levels (4 vs 3; P = .001), required more inpatient opioids (117 oral morphine equivalents [OMEs] vs 70 OMEs; P = .022), were prescribed more opioids at discharge (1163 OMEs vs 750 OMEs; P = .02), and required more long-term opioid refills (57.7% vs 15.4%; P < .001) than patients without depression. However, depression was not associated with increased pain, opioid requirements, prescription quantities, or refill rates among opioid-naive patients. Conclusions Depression is not associated with increased pain or opioid requirements among opioid-naive patients after TJA but is associated with significantly higher pain and opioid requirements among patients who use opioids preoperatively. The interaction of these variables may highlight a target for preoperative counseling and risk modification in the arthroplasty population.
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Affiliation(s)
- William Rubenstein
- Department of Orthopedics, University of California San Francisco, San Francisco, CA, USA
| | - Trevor Grace
- Department of Orthopedics, University of California San Francisco, San Francisco, CA, USA
| | - Rhiannon Croci
- Department of Orthopedics, University of California San Francisco, San Francisco, CA, USA
| | - Derek Ward
- Department of Orthopedics, University of California San Francisco, San Francisco, CA, USA
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Abstract
BACKGROUND Despite the opioid epidemic in the U.S., little data exist to guide postoperative opioid prescribing in Obstetrics & Gynecology (Ob/Gyn). OBJECTIVE To describe Ob/Gyn resident opioid prescription patterns in the U.S. and assess influential factors. METHODS An anonymous survey was emailed to Ob/Gyn residents in the U.S. between January-February 2015. Respondents reported the typical number of discharge narcotic tablets prescribed following six common procedures. Responses to questions addressed potential factors influencing prescription practices and knowledge about opioid abuse in the U.S. Residents who prescribed a number of discharge narcotic tablets in the top quartile were compared to those who never did. Logistic regression was used to identify factors associated with top quartile prescribers. RESULTS 267 residents responded. Median number of discharge narcotics prescribed following cesarean section was 30 (IQR 28, 40) and after laparoscopic hysterectomy was 29 (IQR 20, 30). Factors associated with increased odds of prescribing in the top quartile included training in the West (aOR 3.15, 95% CI 1.05-9.45, p = 0.04) and agreeing with: "I prescribe postoperative narcotics to avoid getting reprimanded by attendings" (aOR 2.72, 95% CI 1.20-6.15, p = 0.02). Factors associated with decreased odds of prescribing in the top quartile included training in a community-based program (aOR 0.33, 95% CI 0.15-0.71, p = 0.005) and agreeing with: "I am conservative with the number of narcotics I prescribe after surgery" (aOR 0.34, 95% CI 0.17-0.71, p = 0.004). Conclusions/Importance: Opioid prescribing practices of Ob/Gyn residents are influenced by region of country, program-type, and factors related to hospital culture and personal insight.
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Affiliation(s)
- Adam D Baruch
- a Department of Obstetrics and Gynecology , University of Michigan , Ann Arbor , Michigan , USA
| | - Daniel McBurney Morgan
- a Department of Obstetrics and Gynecology , University of Michigan , Ann Arbor , Michigan , USA
| | - Vanessa K Dalton
- a Department of Obstetrics and Gynecology , University of Michigan , Ann Arbor , Michigan , USA
| | - Carolyn Swenson
- a Department of Obstetrics and Gynecology , University of Michigan , Ann Arbor , Michigan , USA
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