Naheed K Jivraj1,2,3,4, Karim Ladha5,6, Akash Goel6, Andrea Hill7, Duminda N Wijeysundera5,6, Brian T Bateman8, Hannah Wunsch5,9,10. 1. Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada. naheed.jivraj@mail.utoronto.ca. 2. Institute of Health Policy Management and Evaluation, Toronto, ON, Canada. naheed.jivraj@mail.utoronto.ca. 3. Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada. naheed.jivraj@mail.utoronto.ca. 4. Department of Anesthesiology and Pain Medicine, University of Toronto, 12th Floor, 123 Edward Street, Toronto, ON, M5G 1E2, Canada. naheed.jivraj@mail.utoronto.ca. 5. Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada. 6. Department of Anesthesia and Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada. 7. Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada. 8. Department of Anesthesia, Perioperative, and Pain Medicine, and Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA. 9. Institute of Health Policy Management and Evaluation, Toronto, ON, Canada. 10. Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
Abstract
PURPOSE: Many hospital and provincial-level recommendations now advise a tailored approach to postoperative opioid prescribing; recent trends in postoperative prescribing at the population level have not been well described. METHODS: This population-based cohort study included opioid-naïve patients ≥ 18 yr of age who underwent one of 16 surgical procedures with varying anticipated postoperative pain between July 2013 and March 2020. We evaluated the rate of filled opioid prescriptions within seven days postoperatively, the total morphine milligram equivalent (MME) dose, duration, and type of the first opioid prescription. We then compared the MMEs in initial opioid prescriptions with available procedure-specific recommendations. RESULTS: The sample included 900,989 opioid-naïve patients (mean [standard deviation (SD)] age of 50 [17] 31 yr; 66% women). The percentage of patients filling an opioid prescription within 7 days postoperatively increased from 65% in 2013 to 69% in 2016, and returned to the baseline (65%) in 2019. The mean (SD) MMEs dispensed increased until 2015/2016 and then declined (226 [176] MMEs in 2013, 240 [202] MMEs in 2016, and 175 [175] MMEs in 2019). The most frequently prescribed opioid in 2013 was oxycodone compared with hydromorphone in 2019. Among patients who filled an opioid prescription in 2013, 67% were prescribed an opioid dose higher than those in one set of available prescribing recommendations, while in 2019, 41% were prescribed doses above those stated in recommendations. CONCLUSION: While the proportion of patients filling an opioid prescription postoperatively remained s during the study period, MMEs decreased after 2016. Opioid prescribing remained significantly higher than available prescribing recommendations, particularly among low pain procedures. These findings highlight the need to identify strategies that improve adherence to surgery-specific prescribing guidelines in North America.
PURPOSE: Many hospital and provincial-level recommendations now advise a tailored approach to postoperative opioid prescribing; recent trends in postoperative prescribing at the population level have not been well described. METHODS: This population-based cohort study included opioid-naïve patients ≥ 18 yr of age who underwent one of 16 surgical procedures with varying anticipated postoperative pain between July 2013 and March 2020. We evaluated the rate of filled opioid prescriptions within seven days postoperatively, the total morphine milligram equivalent (MME) dose, duration, and type of the first opioid prescription. We then compared the MMEs in initial opioid prescriptions with available procedure-specific recommendations. RESULTS: The sample included 900,989 opioid-naïve patients (mean [standard deviation (SD)] age of 50 [17] 31 yr; 66% women). The percentage of patients filling an opioid prescription within 7 days postoperatively increased from 65% in 2013 to 69% in 2016, and returned to the baseline (65%) in 2019. The mean (SD) MMEs dispensed increased until 2015/2016 and then declined (226 [176] MMEs in 2013, 240 [202] MMEs in 2016, and 175 [175] MMEs in 2019). The most frequently prescribed opioid in 2013 was oxycodone compared with hydromorphone in 2019. Among patients who filled an opioid prescription in 2013, 67% were prescribed an opioid dose higher than those in one set of available prescribing recommendations, while in 2019, 41% were prescribed doses above those stated in recommendations. CONCLUSION: While the proportion of patients filling an opioid prescription postoperatively remained s during the study period, MMEs decreased after 2016. Opioid prescribing remained significantly higher than available prescribing recommendations, particularly among low pain procedures. These findings highlight the need to identify strategies that improve adherence to surgery-specific prescribing guidelines in North America.
Authors: Chad M Brummett; Jennifer F Waljee; Jenna Goesling; Stephanie Moser; Paul Lin; Michael J Englesbe; Amy S B Bohnert; Sachin Kheterpal; Brahmajee K Nallamothu Journal: JAMA Surg Date: 2017-06-21 Impact factor: 14.766
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Authors: Sinéad M Langan; Sigrún Aj Schmidt; Kevin Wing; Vera Ehrenstein; Stuart G Nicholls; Kristian B Filion; Olaf Klungel; Irene Petersen; Henrik T Sorensen; William G Dixon; Astrid Guttmann; Katie Harron; Lars G Hemkens; David Moher; Sebastian Schneeweiss; Liam Smeeth; Miriam Sturkenboom; Erik von Elm; Shirley V Wang; Eric I Benchimol Journal: BMJ Date: 2018-11-14
Authors: Gabriel A Brat; Denis Agniel; Andrew Beam; Brian Yorkgitis; Mark Bicket; Mark Homer; Kathe P Fox; Daniel B Knecht; Cheryl N McMahill-Walraven; Nathan Palmer; Isaac Kohane Journal: BMJ Date: 2018-01-17