Discharge Prescribing and Subsequent Opioid Use After Traumatic Musculoskeletal Injury

被引:1
作者
Basilico, Matthew F. [1 ,2 ]
Bhashyam, Abhiram R. [5 ,6 ]
Harrington, Emma K. [1 ]
Bharel, Monica [7 ,8 ]
McWilliams, J. Michael [3 ,9 ]
Heng, Marilyn [4 ,10 ,11 ]
机构
[1] Harvard Univ, Dept Econ, Cambridge, MA 02138 USA
[2] Harvard Med Sch, Dept Global Hlth & Social Med, Boston, MA 02115 USA
[3] Harvard Med Sch, Dept Hlth Care Policy, Boston, MA 02115 USA
[4] Harvard Med Sch, Harvard Orthopaed Trauma Initiat, Boston, MA 02115 USA
[5] Harvard Combined Orthopaed Residency Program, Boston, MA USA
[6] Massachusetts Gen Hosp, Dept Orthopaed Surg, Boston, MA USA
[7] Massachusetts Dept Publ Hlth, Boston, MA USA
[8] Adv Clin, Boston, MA USA
[9] Brigham & Womens Hosp, Div Gen Internal Med & Primary Care, 75 Francis St, Boston, MA 02115 USA
[10] Massachusetts Gen Hosp, Dept Orthopaed Surg, Boston, MA 02114 USA
[11] Univ Miami, Miller Sch Med, Dept Orthopaed, Miami, FL USA
关键词
UNITED-STATES; PATTERNS; ASSOCIATION; EPIDEMIC;
D O I
10.37765/ajmc.2023.89424
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
OBJECTIVE: To investigate the effects of discharge opioid supply after surgery for musculoskeletal injury on subsequent opioid use. STUDY DESIGN: Instrumental variables analysis of retrospective administrative data. METHODS: Data were acquired on 1039 patients treated operatively for a musculoskeletal injury between 2011 and 2015 at 2 level I trauma centers. State registry data were used to track all postoperative opioid prescription fills. Discharge surgical resident was identified for each patient. We categorized residents in the top one-third of opioid prescribing as high-supply residents and others as low-supply residents, with adjustment for service attending physician and month. The primary outcome was subsequent opioid use, defined as new opioid prescriptions and cumulative prescribed opioid supply 7 to 8 months after injury. RESULTS: On average, patients of high-supply residents received an additional 96 morphine milligram equivalents (MME) at discharge (95% CI, 29-163 MME; P <.01), or 16% more, compared with patients of low-supply residents, which is equivalent to an additional 2-day supply at a typical dosage. In the seventh or eighth month after surgery, patients of high-supply residents received a greater total MME volume than patients of low-supply residents (difference, 13.0 MME; 95% CI, 3.1-22.9 MME; P <.01) despite receiving a greater cumulative supply of opioid medications through the sixth month after surgery. CONCLUSIONS: After surgery for musculoskeletal injury, patients discharged by residents who prescribe greater supplies of opioid pain medications received higher supplies of opioids 7 to 8 months after surgery than patients discharged by residents who tend to prescribe less. Thus, limiting postoperative supplies of opioid pain medication may help reduce chronic opioid use.
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页码:448 / +
页数:10
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