Impact of an Australian/New Zealand organisational position statement on extended-release opioid prescribing among surgical inpatients: a dual centre before-and-after study

被引：15

作者：

Awadalla, R. ^{[1
]}

Liu, S. ^{[2
]}

Kemp-Casey, A. ^{[4
]}

Gnjidic, D. ^{[1
]}

Patanwala, A. ^{[1
]}

Stevens, J. ^{[5
,6
]}

Begley, D. ^{[3
]}

Bugeja, B. ^{[3
]}

Penm, J. ^{[1
,2
]}

机构：

[1] Univ Sydney, Sch Pharm, Fac Med & Hlth, Sydney, NSW, Australia

[2] Prince Wales Hosp, Dept Pharm, Randwick, NSW, Australia

[3] Prince Wales Hosp, Dept Pain Management, Randwick, NSW, Australia

[4] Univ South Australia, Qual Use Med & Pharm Res Ctr, Clin & Hlth Sci, Adelaide, SA, Australia

[5] Univ New South Wales, Sydney, NSW, Australia

[6] Univ Notre Dame, Sydney, NSW, Australia

来源：

ANAESTHESIA | 2021年 / 76卷 / 12期

基金：

英国医学研究理事会;

关键词：

extended‐ release opioid; long‐ acting opioid; opioid epidemic; opioid prescription; opioids; position statement; CHRONIC PAIN; MANAGEMENT; GUIDELINE; PATTERNS;

D O I：

10.1111/anae.15500

中图分类号：

R614 [麻醉学];

学科分类号：

100217 ;

摘要：

Extended-release opioids are often prescribed to manage postoperative pain despite being difficult to titrate to analgesic requirements and their association with long-term opioid use. An Australian/New Zealand organisational position statement released in March 2018 recommended avoiding extended-release opioid prescribing for acute pain. This study aimed to evaluate the impact of this organisational position statement on extended-release opioid prescribing among surgical inpatients. Secondary objectives included predictors and clinical outcomes of prescribing extended-release opioids among surgical inpatients. We conducted a retrospective, dual centre, 11-month before-and-after study and time-series analysis by utilising electronic medical records from two teaching hospitals in Sydney, Australia. The primary outcome was the proportion of patients prescribed an extended-release opioid. For surgical patients prescribed any opioid (n = 16,284), extended-release opioid prescribing decreased after the release of the position statement (38.4% before vs. 26.6% after, p < 0.001), primarily driven by a reduction in extended-release oxycodone (31.1% before vs. 14.1% after, p < 0.001). There was a 23% immediate decline in extended-release opioid prescribing after the position statement release (p < 0.001), followed by an additional 0.2% decline per month in the following months. Multivariable regression showed that the release of the position statement was associated with a decrease in extended-release opioid prescribing (OR 0.54, 95%CI 0.50-0.58). Extended-release opioid prescribing was also associated with increased incidence of opioid-related adverse events (OR 1.52, 95%CI 1.35-1.71); length of stay (RR 1.44, 95%CI 1.39-1.51); and 28-day re-admission (OR 1.26, 95%CI 1.12-1.41). Overall, a reduction in extended-release opioid prescribing was observed in surgical inpatients following position statement release.

引用

页码：1607 / 1615

页数：9