Lindsey E Dayer, Cheng Peng, Adrian J Williams, Lisa Luciani, Joshua Lowery, Brittany Butterfield, Jacob T Painter
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The study was determined not to be human subject research by the local institutional review board.</p><p><strong>Results: </strong>Our final sample consisted of 4367 patients that met the eligibility criteria. Of these patients, 1347 (30.84%) had been discharged on morphine equivalent daily dose (MEDD) greater than the previously administered 24-h MEDD. After adjusting for other covariates, the logistic regression analysis of the length of surgery showed that the risk of opioid overprescribing increased as the surgery lasted longer (adjusted odds ratio [AOR] 1.150, 95% confidence interval [CI] 1.099-1.202) and showed that older patients (AOR 1.010, 95% CI 1.006-1.015), males (AOR 1.168, 95% CI 1.006-1.356), non-White individuals (AOR 1.192, 95% CI 1.029-1.380), and patients who experienced lower average pain scores (AOR 0.789, 95% CI 0.757-0.823) had a significantly higher risk of opioid overprescribing.</p><p><strong>Conclusions: </strong>Overprescribing at discharge could result in unnecessary opioids in the community, which may, in turn, lead to opioid abuse, misuse, and diversion. Based on our study, opioid prescribing at discharge is often driven by factors other than inpatient opioid use. Therefore, considering patient-specific factors such as MEDD 24 h before discharge may be one of the most useful tools to help guide opioid prescribing.</p>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"306 ","pages":"224-229"},"PeriodicalIF":1.8000,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Factors Contributing to Opioid Overprescribing at Surgical Discharge.\",\"authors\":\"Lindsey E Dayer, Cheng Peng, Adrian J Williams, Lisa Luciani, Joshua Lowery, Brittany Butterfield, Jacob T Painter\",\"doi\":\"10.1016/j.jss.2024.11.034\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>Opioids remain the gold standard for treating acute pain, whereas overprescribing occurs regularly in the postoperative setting with little clinical guidance. 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引用次数: 0
摘要
阿片类药物仍然是治疗急性疼痛的金标准，然而在缺乏临床指导的情况下，术后经常出现过量处方。本研究的目的是检查手术时间是否是出院时阿片类药物过量处方的独立危险因素。方法：我们进行了一项回顾性病例对照研究，以确定手术时间长短与过量使用阿片类药物之间是否存在关联。实验地点是位于美国南部地区的一个学术医疗中心——一个成人一级创伤中心。它是一所综合医疗和外科设施，也是一所教学医院。该研究被当地机构审查委员会确定为非人体研究。结果：我们最终的样本包括4367例符合资格标准的患者。其中，1347例（30.84%）患者出院时吗啡当量日剂量（MEDD）大于先前给予的24小时MEDD。在校正其他协变量后，手术时间的logistic回归分析显示，阿片类药物过量处方的风险随着手术时间的延长而增加（调整优势比[AOR] 1.150, 95%可信区间[CI] 1.099-1.202），老年患者（AOR 1.010, 95% CI 1.006-1.356）、男性（AOR 1.168, 95% CI 1.006-1.356）、非白人（AOR 1.192, 95% CI 1.029-1.380）和平均疼痛评分较低的患者(AOR 0.789，95% CI 0.757-0.823)阿片类药物过量处方的风险明显较高。结论：出院时的过量处方可能导致社区不必要的阿片类药物，这可能反过来导致阿片类药物滥用、误用和转移。根据我们的研究，出院时的阿片类药物处方通常是由住院患者阿片类药物使用以外的因素驱动的。因此，考虑患者的具体因素，如出院前24小时的MEDD可能是帮助指导阿片类药物处方的最有用的工具之一。
Factors Contributing to Opioid Overprescribing at Surgical Discharge.
Introduction: Opioids remain the gold standard for treating acute pain, whereas overprescribing occurs regularly in the postoperative setting with little clinical guidance. The objective of this study is to examine whether the length of surgery is an independent risk factor for opioid overprescribing at discharge.
Methods: We conducted a retrospective case-control study to determine if there is an association between the length of surgery and overprescribed opioids. The setting was an academic medical center located in the southern region of the United States - an adult level-one trauma center. It is a general medical and surgical facility and a teaching hospital. The study was determined not to be human subject research by the local institutional review board.
Results: Our final sample consisted of 4367 patients that met the eligibility criteria. Of these patients, 1347 (30.84%) had been discharged on morphine equivalent daily dose (MEDD) greater than the previously administered 24-h MEDD. After adjusting for other covariates, the logistic regression analysis of the length of surgery showed that the risk of opioid overprescribing increased as the surgery lasted longer (adjusted odds ratio [AOR] 1.150, 95% confidence interval [CI] 1.099-1.202) and showed that older patients (AOR 1.010, 95% CI 1.006-1.015), males (AOR 1.168, 95% CI 1.006-1.356), non-White individuals (AOR 1.192, 95% CI 1.029-1.380), and patients who experienced lower average pain scores (AOR 0.789, 95% CI 0.757-0.823) had a significantly higher risk of opioid overprescribing.
Conclusions: Overprescribing at discharge could result in unnecessary opioids in the community, which may, in turn, lead to opioid abuse, misuse, and diversion. Based on our study, opioid prescribing at discharge is often driven by factors other than inpatient opioid use. Therefore, considering patient-specific factors such as MEDD 24 h before discharge may be one of the most useful tools to help guide opioid prescribing.
期刊介绍：
The Journal of Surgical Research: Clinical and Laboratory Investigation publishes original articles concerned with clinical and laboratory investigations relevant to surgical practice and teaching. The journal emphasizes reports of clinical investigations or fundamental research bearing directly on surgical management that will be of general interest to a broad range of surgeons and surgical researchers. The articles presented need not have been the products of surgeons or of surgical laboratories.
The Journal of Surgical Research also features review articles and special articles relating to educational, research, or social issues of interest to the academic surgical community.
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