Author:
Pommerening Matthew J.,Landau Aaron,Hrebinko Katherine,Luketich James D.,Dhupar Rajeev
Abstract
AbstractThe opioid crisis is a public health issue and has been linked to physician overprescribing. Pain management after thoracic surgery is not standardized at many centers, and we hypothesized that excessive narcotics were being dispensed on discharge. As a quality improvement initiative, we sought to understand current prescribing practices to better align the amount of opioids dispensed on discharge to actual patient needs. This was a single-center, retrospective review of patients undergoing thoracic surgery from 7/2015 to 7/2018. Demographics, operative data, perioperative pain medication use, and discharge pain medication prescriptions were analyzed. Opioids were converted to Morphine Milligram Equivalents (MME). Among 124 patients, 103 (83%) received intraoperative nerve blocks and 106 (85.5%) used PCAs. Prescribed MME/day at discharge were significantly higher than MME/day received during hospitalization (Median 30 [IQR 30–45] vs. 15 [IQR 5–24], p < 0.001) and were not associated with receiving a nerve block or PCA. By procedure, prescribed MME/day were significantly higher than inpatient MME/day for wedge resections (p < 0.001), segmentectomies (p = 0.02), lobectomies (p = 0.003), and thymectomies (p = 0.02). Patients are being discharged with significantly more opioids than they are using as inpatients. Education among prescribers and a standardized approach with patient-specific dosing may reduce excessive opioid dispensing.
Funder
Department of Cardiothoracic Surgery, University of Pittsburgh
Dean's Faculty Advancement Award, University of Pittsburgh School of Medicine
Publisher
Springer Science and Business Media LLC
Reference12 articles.
1. Hedegaard, H., Warner, M. & Minino, A. M. Drug overdose deaths in the United States, 1999–2015. NCHS Data Br. 2017, 1–8 (2017).
2. Santosa, K. B. et al. New persistent opioid use among older patients following surgery: A medicare claims analysis. Surgery 167(4), 732–742 (2020).
3. Centers for Disease C, Prevention. Vital signs: Overdoses of prescription opioid pain relievers—United States, 1999–2008. MMWR Morb. Mortal Wkly. Rep. 60, 1487–1492 (2011).
4. Chiu, A. S., Healy, J. M., DeWane, M. P., Longo, W. E. & Yoo, P. S. Trainees as agents of change in the opioid epidemic: Optimizing the opioid prescription practices of surgical residents. J. Surg. Educ. 75, 65–71 (2018).
5. Bohnert, A. S. et al. Association between opioid prescribing patterns and opioid overdose-related deaths. JAMA 305, 1315–1321 (2011).
Cited by
7 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献