Delano Trenchfield, Sebastian Fras, Michael McCurdy, Rajkishen Narayanan, Yunsoo Lee, Tariq Issa, Gregory Toci, Yazan Oghli, Hassan Siddiqui, Michael Vo, Hamd Mahmood, Meghan Schilken, Bahram Pashaee, John Mangan, Mark Kurd, Ian David Kaye, Jose A Canseco, Alan S Hilibrand, Alexander R Vaccaro, Christopher K Kepler, Gregory D Schroeder
{"title":"脊柱手术患者中骨科、初级保健和疼痛管理提供者的阿片类药物处方趋势。","authors":"Delano Trenchfield, Sebastian Fras, Michael McCurdy, Rajkishen Narayanan, Yunsoo Lee, Tariq Issa, Gregory Toci, Yazan Oghli, Hassan Siddiqui, Michael Vo, Hamd Mahmood, Meghan Schilken, Bahram Pashaee, John Mangan, Mark Kurd, Ian David Kaye, Jose A Canseco, Alan S Hilibrand, Alexander R Vaccaro, Christopher K Kepler, Gregory D Schroeder","doi":"10.5435/JAAOS-D-24-00167","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To determine prescription trends across specialties in the perioperative care of patients undergoing spine surgery from 2018 to 2021.</p><p><strong>Summary of background data: </strong>A range of measures, including implementation of state prescription drug monitoring programs, have been instituted to combat the opioid epidemic. Considering the continued presence of opioids for spine-related pain management, a better understanding of the patterns of opioid prescription practices may be important for future intervention.</p><p><strong>Methods: </strong>All patients aged 18 years and older who underwent elective posterior lumbar decompression and fusion, transforaminal lumbar interbody fusion, and anterior cervical diskectomy and fusion from 2018 to 2021 were retrospectively identified. Patient demographics and surgical characteristics were collected through a Structured Query Language search and manual chart review. Opioid prescription data were collected through Pennsylvania's Prescription Drug Monitoring Program (PDMP) database and grouped into the following prescriber categories: primary care, pain management, physiatry, and orthopaedic surgery.</p><p><strong>Results: </strong>Of the 1,062 patients, 302 (28.4%) underwent anterior cervical diskectomy and fusion, 345 (32.4%) underwent posterior lumbar decompression and fusion, and 415 (39.1%) underwent transforaminal lumbar interbody fusion. From 2018 to 2021, there were no significant differences in total opioid prescriptions from orthopaedic surgery ( P = 0.892), primary care ( P = 0.571), pain management ( P = 0.687), or physiatry ( P = 0.391) providers. Pain management providers prescribed the most opioids between 1 year and 2 months preoperatively ( P = 0.003), between 2 months and 1 year postoperatively ( P = 0.018), and overall ( P < 0.001).</p><p><strong>Conclusion: </strong>Despite increasing national awareness of the opioid epidemic and the establishment of statewide prescription drug monitoring programs, prescription rates have not changed markedly in spine patients. Pain management and primary care physicians prescribe opioids at a higher rate in the chronic periods before and after surgery, likely in part because of longitudinal relationships with these patients.</p><p><strong>Level of evidence: </strong>III.</p><p><strong>Study design: </strong>Retrospective Cohort Study.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"e1252-e1259"},"PeriodicalIF":2.6000,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Opioid Prescription Trends Among Orthopaedic, Primary Care, and Pain Management Providers in Spine Surgery Patients.\",\"authors\":\"Delano Trenchfield, Sebastian Fras, Michael McCurdy, Rajkishen Narayanan, Yunsoo Lee, Tariq Issa, Gregory Toci, Yazan Oghli, Hassan Siddiqui, Michael Vo, Hamd Mahmood, Meghan Schilken, Bahram Pashaee, John Mangan, Mark Kurd, Ian David Kaye, Jose A Canseco, Alan S Hilibrand, Alexander R Vaccaro, Christopher K Kepler, Gregory D Schroeder\",\"doi\":\"10.5435/JAAOS-D-24-00167\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>To determine prescription trends across specialties in the perioperative care of patients undergoing spine surgery from 2018 to 2021.</p><p><strong>Summary of background data: </strong>A range of measures, including implementation of state prescription drug monitoring programs, have been instituted to combat the opioid epidemic. Considering the continued presence of opioids for spine-related pain management, a better understanding of the patterns of opioid prescription practices may be important for future intervention.</p><p><strong>Methods: </strong>All patients aged 18 years and older who underwent elective posterior lumbar decompression and fusion, transforaminal lumbar interbody fusion, and anterior cervical diskectomy and fusion from 2018 to 2021 were retrospectively identified. Patient demographics and surgical characteristics were collected through a Structured Query Language search and manual chart review. Opioid prescription data were collected through Pennsylvania's Prescription Drug Monitoring Program (PDMP) database and grouped into the following prescriber categories: primary care, pain management, physiatry, and orthopaedic surgery.</p><p><strong>Results: </strong>Of the 1,062 patients, 302 (28.4%) underwent anterior cervical diskectomy and fusion, 345 (32.4%) underwent posterior lumbar decompression and fusion, and 415 (39.1%) underwent transforaminal lumbar interbody fusion. From 2018 to 2021, there were no significant differences in total opioid prescriptions from orthopaedic surgery ( P = 0.892), primary care ( P = 0.571), pain management ( P = 0.687), or physiatry ( P = 0.391) providers. Pain management providers prescribed the most opioids between 1 year and 2 months preoperatively ( P = 0.003), between 2 months and 1 year postoperatively ( P = 0.018), and overall ( P < 0.001).</p><p><strong>Conclusion: </strong>Despite increasing national awareness of the opioid epidemic and the establishment of statewide prescription drug monitoring programs, prescription rates have not changed markedly in spine patients. Pain management and primary care physicians prescribe opioids at a higher rate in the chronic periods before and after surgery, likely in part because of longitudinal relationships with these patients.</p><p><strong>Level of evidence: </strong>III.</p><p><strong>Study design: </strong>Retrospective Cohort Study.</p>\",\"PeriodicalId\":51098,\"journal\":{\"name\":\"Journal of the American Academy of Orthopaedic Surgeons\",\"volume\":\" \",\"pages\":\"e1252-e1259\"},\"PeriodicalIF\":2.6000,\"publicationDate\":\"2024-12-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of the American Academy of Orthopaedic Surgeons\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.5435/JAAOS-D-24-00167\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/8/22 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of the American Academy of Orthopaedic Surgeons","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.5435/JAAOS-D-24-00167","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/8/22 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
Opioid Prescription Trends Among Orthopaedic, Primary Care, and Pain Management Providers in Spine Surgery Patients.
Objective: To determine prescription trends across specialties in the perioperative care of patients undergoing spine surgery from 2018 to 2021.
Summary of background data: A range of measures, including implementation of state prescription drug monitoring programs, have been instituted to combat the opioid epidemic. Considering the continued presence of opioids for spine-related pain management, a better understanding of the patterns of opioid prescription practices may be important for future intervention.
Methods: All patients aged 18 years and older who underwent elective posterior lumbar decompression and fusion, transforaminal lumbar interbody fusion, and anterior cervical diskectomy and fusion from 2018 to 2021 were retrospectively identified. Patient demographics and surgical characteristics were collected through a Structured Query Language search and manual chart review. Opioid prescription data were collected through Pennsylvania's Prescription Drug Monitoring Program (PDMP) database and grouped into the following prescriber categories: primary care, pain management, physiatry, and orthopaedic surgery.
Results: Of the 1,062 patients, 302 (28.4%) underwent anterior cervical diskectomy and fusion, 345 (32.4%) underwent posterior lumbar decompression and fusion, and 415 (39.1%) underwent transforaminal lumbar interbody fusion. From 2018 to 2021, there were no significant differences in total opioid prescriptions from orthopaedic surgery ( P = 0.892), primary care ( P = 0.571), pain management ( P = 0.687), or physiatry ( P = 0.391) providers. Pain management providers prescribed the most opioids between 1 year and 2 months preoperatively ( P = 0.003), between 2 months and 1 year postoperatively ( P = 0.018), and overall ( P < 0.001).
Conclusion: Despite increasing national awareness of the opioid epidemic and the establishment of statewide prescription drug monitoring programs, prescription rates have not changed markedly in spine patients. Pain management and primary care physicians prescribe opioids at a higher rate in the chronic periods before and after surgery, likely in part because of longitudinal relationships with these patients.
期刊介绍：
The Journal of the American Academy of Orthopaedic Surgeons was established in the fall of 1993 by the Academy in response to its membership’s demand for a clinical review journal. Two issues were published the first year, followed by six issues yearly from 1994 through 2004. In September 2005, JAAOS began publishing monthly issues.
Each issue includes richly illustrated peer-reviewed articles focused on clinical diagnosis and management. Special features in each issue provide commentary on developments in pharmacotherapeutics, materials and techniques, and computer applications.
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