2024-06-28 ミシガン大学
<関連情報>
- https://news.umich.edu/a-few-surgical-procedures-account-for-high-number-of-opioid-prescriptions/
- https://publications.aap.org/pediatrics/article-abstract/154/1/e2024065814/197573/Pediatric-Surgical-Opioid-Prescribing-by-Procedure
- https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2820373
小児外科用オピオイド処方、手技別、2020-2021年 Pediatric Surgical Opioid Prescribing by Procedure, 2020–2021
Kao-Ping Chua, MD, PhD;Chad M. Brummett, MD;Lorraine I. Kelley-Quon, MD, MSHS;Mark C. Bicket, MD, PhD;Vidhya Gunaseelan, MBA, MS, MHA;Jennifer F. Waljee, MD, MPH, MS
Pediatrics Published:June 26 2024
DOI:https://doi.org/10.1542/peds.2024-065814
BACKGROUND AND OBJECTIVES
Surgery is one of the most common indications for opioid prescribing to pediatric patients. We identified which procedures account for the most pediatric surgical opioid prescribing.
METHODS
We conducted a cross-sectional analysis of commercial and Medicaid claims in the Merative MarketScan Commercial and Multi-State Medicaid Databases. Analyses included surgical procedures for patients aged 0 to 21 years from December 1, 2020, to November 30, 2021. Procedures were identified using a novel crosswalk between 3664 procedure codes and 1082 procedure types. For each procedure type in the crosswalk, we calculated the total amount of opioids in prescriptions dispensed within 3 days of discharge from surgery, as measured in morphine milligram equivalents (MMEs). We then calculated the share of all MMEs accounted for by each procedure type. We conducted analyses separately among patients aged 0 to 11 and 12 to 21 years.
RESULTS
Among 107 597 procedures for patients aged 0 to 11 years, the top 3 procedures accounted for 59.1% of MMEs in opioid prescriptions dispensed after surgery: Tonsillectomy and/or adenoidectomy (50.3%), open treatment of upper extremity fracture (5.3%), and removal of deep implants (3.5%). Among 111 406 procedures for patients aged 12 to 21 years, the top 3 procedures accounted for 33.1% of MMEs: Tonsillectomy and/or adenoidectomy (12.7%), knee arthroscopy (12.6%), and cesarean delivery (7.8%).
CONCLUSIONS
Pediatric surgical opioid prescribing is concentrated among a small number of procedures. Targeting these procedures in opioid stewardship initiatives could help minimize the risks of opioid prescribing while maintaining effective postoperative pain control.
成人における外科手術退院後のオピオイド処方の疫学 Epidemiology of Opioid Prescribing After Discharge From Surgical Procedures Among Adults
Dominic Alessio-Bilowus, BS; Kao-Ping Chua, MD, PhD; Alex Peahl, MD, MSc; et al
JAMA Network Open Published:June 26, 2024
DOI:10.1001/jamanetworkopen.2024.17651
Key Points
Question Which procedures account for the most opioids dispensed to adults after surgery?
Findings In a cross-sectional analysis of claims data for more than 1 million major surgical procedures among privately and publicly insured adults, cesarean delivery accounted for the largest proportion of opioids dispensed after surgery among individuals aged 18 to 44 years. Among procedures accounting for the 5 highest proportions of opioids dispensed after surgery to individuals aged 45 to 64 years, 4 were orthopedic procedures.
Meaning These findings suggest that the design and targeting of surgical opioid stewardship initiatives for adults should focus on the procedures that account for the greatest share of postoperative opioid prescribing.
Abstract
Importance Opioid medications are commonly prescribed for the management of acute postoperative pain. In light of increasing awareness of the potential risks of opioid prescribing, data are needed to define the procedures and populations for which most opioid prescribing occurs.
Objective To identify the surgical procedures accounting for the highest proportion of opioids dispensed to adults after surgery in the United States.
Design, Setting, and Participants This cross-sectional analysis of the 2020-2021 Merative MarketScan Commercial and Multi-State Databases, which capture medical and pharmacy claims for 23 million and 14 million annual privately insured patients and Medicaid beneficiaries, respectively, included surgical procedures for individuals aged 18 to 64 years with a discharge date between December 1, 2020, and November 30, 2021. Procedures were identified using a novel crosswalk between 3664 Current Procedural Terminology codes and 1082 procedure types. Data analysis was conducted from November to December 2023.
Main Outcomes and Measures The total amount of opioids dispensed within 3 days of discharge from surgery across all procedures in the sample, as measured in morphine milligram equivalents (MMEs), was calculated. The primary outcome was the proportion of total MMEs attributable to each procedure type, calculated separately among procedures for individuals aged 18 to 44 years and those aged 45 to 64 years.
Results Among 1 040 934 surgical procedures performed (mean [SD] age of patients, 45.5 [13.3] years; 663 609 [63.7%] female patients), 457 016 (43.9%) occurred among individuals aged 18 to 44 years and 583 918 (56.1%) among individuals aged 45 to 64 years. Opioid prescriptions were dispensed for 503 058 procedures (48.3%). Among individuals aged 18 to 44 years, cesarean delivery accounted for the highest proportion of total MMEs dispensed after surgery (19.4% [11 418 658 of 58 825 364 MMEs]). Among individuals aged 45 to 64 years, 4 of the top 5 procedures were common orthopedic procedures (eg, arthroplasty of knee, 9.7% of total MMEs [5 885 305 of 60 591 564 MMEs]; arthroscopy of knee, 6.5% [3 912 616 MMEs]).
Conclusions and Relevance In this cross-sectional study of the distribution of postoperative opioid prescribing in the United States, a small number of common procedures accounted for a large proportion of MMEs dispensed after surgery. These findings suggest that the optimal design and targeting of surgical opioid stewardship initiatives in adults undergoing surgery should focus on the procedures that account for the most opioid dispensed following surgery over the life span, such as childbirth and orthopedic procedures. Going forward, systems that provide periodic surveillance of opioid prescribing and associated harms can direct quality improvement initiatives to reduce opioid-related morbidity and mortality.
