REDUCTION IN DISPENSED OPIOIDS AND CHRONIC POSTOPERATIVE OPIOID USE IN OUTPATIENT ORTHOPAEDIC PATIENTS: A POPULATION-BASED STUDY OF THE IMPLEMENTATION OF AN INSTITUTIONAL PROTOCOL
Notice bibliographique
Résumé
The opioid epidemic is a complex issue with multiple sources of origin and proliferating factors, including physician overprescribing. Due to the painful nature of orthopaedic procedures, orthopaedic surgeons face pressure to prescribe opioids to control pain in the peri-operative period. As such, they are some of the highest prescribers of opioids among all medical specialties. A number of studies have shown decreases in opioid prescribing by orthopaedic surgeons following introduction of legislation setting prescription limits and strategies such as patient education programs or restrictive prescription protocols. While these studies have shown good outcomes, there is a scarcity of literature evaluating these strategies at an institutional level. The purpose of this study is to evaluate the effectiveness of a multimodal opioid restriction protocol implemented at an outpatient Canadian sports orthopaedic surgery institution. This was a retrospective pre-post intervention study using deidentified data housed by a provincial government agency. All opioid naïve patients that underwent outpatient shoulder or knee surgery at our institution between January 2013 and December 2018, and July 2020 and March 2022, were included (n = 10,449). Patients who filled a prescription for opioids in the six months preceding their surgery, and those who had surgery during the implementation period, (January 2019 to June 2020) were excluded. The intervention was a three-pronged approach and included distribution of an educational pamphlet, targeted messaging by perioperative nursing staff around opioid use and a restricted prescription protocol consisting of acetaminophen, ibuprofen and a short course of tramadol for instances of intolerable break through pain. The primary outcome was morphine milligram equivalents (MME) per patient, calculated using prescriptions filled in the post-operative period and compared using a t-test. A binary variable was generated indicating if a patient filled an opioid prescription after 180 days post-surgery to evaluate chronic use. A multivariable logistic regression was performed evaluating the effect of the intervention, as well as independent variables, including age, sex, pre-existing mental health diagnoses, SEFI-2 score and Charlson Comorbidity Score. Average MME per patient decreased 18% (321 to 263; p < 0 .001). The proportion of patients filling opioid prescriptions at 180 days post-surgery decreased from 4.8 to 2.6% (p < 0 .001) for a relative risk reduction of 43.8%. The odds of filling an opioid prescription were lower after implementation of the restriction protocol (OR 0.53, p < 0 .001). Middle age, lower socioeconomic status, increased medical comorbidity and pre-existing mental health diagnoses were all associated with an increased risk of continuing to fill prescriptions for opioids at 180 days post operative. Adherence to the protocol was estimated to be high as 71% of patients used tramadol post operatively. The amount of opioids dispensed and the number of chronic opioid users were reduced for outpatients shoulder and knee surgery patients following the institution-wide implementation of a multimodal opioid reduction protocol. This protocol could serve as a model for other institutions to implement effective strategies to decrease opioid dependency resulting from early post-operative pain management.
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Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».