Use of Prescription Opioids Following Surgery and Associated Adverse Patient Outcomes in Older Adults

老年人手术后处方阿片类药物的使用和相关的不良患者结果

• 批准号: 10017798
• 负责人: Anupam Bapu Jena
• 金额: $ 67.75万
• 依托单位: HARVARD MEDICAL SCHOOL
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-15 至 2022-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10017798
• 关键词: Adoption; Adult; Adverse effects; Adverse event; Affect; Attention; Behavior; Caring; Centers for Disease Control and Prevention (U.S.); Characteristics; Chronic; Clinical; Conduction Anesthesia; Data; Dependence; Dose; Elderly; Emergency Situation; Epidemic; Fracture; General Anesthesia; Health system; Hospitalization; Hospitals; Individual; Label; Lead; Local anesthesia; Long-Term Effects; Measurement; Medicare; Methods; Nature; Operative Surgical Procedures; Opiate Addiction; Opioid; Pain; Pain management; Patient-Focused Outcomes; Patients; Pattern; Physicians; Policies; Postoperative Pain; Postoperative Period; Probability; Procedures; Provider; Public Health; Reporting; Research; Research Methodology; Resources; Risk; Role; Safety; Selection Bias; Standardization; Surgeon; Techniques; Time; United States; Variant; adverse outcome; authority; base; beneficiary; design; experimental study; falls; hip surgery; hospitalization rates; human old age (65+); improved; inpatient surgery; mortality; novel; opioid epidemic; opioid overdose; opioid use; overdose death; pain reduction; pain sensation; patient variability; peer; prescription opioid; prescription opioid abuse; side effect; treatment duration; trend

Project Summary/Abstract Rates of opioid prescribing and opioid-related overdose deaths have quadrupled in the United States over the past 25 years. This epidemic has increasingly affected older adults, among whom hospitalization rates for opioid overdoses grew five-fold from 1993-2012. Risks of opioid use are particularly pronounced for older adults, who are vulnerable to opioids’ side effects. Although substantial attention has been placed on inappropriate prescribing of opioids, the ways in which opioid-naïve patients develop long-term opioid use are mostly unknown. One of the most common settings for older adults to receive opioids is after surgery. The period after surgery is a particularly vulnerable one for opioid use, both because of older adults’ clinical fragility after surgery and because the post-hospitalization period often involves a highly fragmented transition of care. However, little data exist on the extent to which opioids are prescribed following surgery among older adults, surgeries for which prescribing and opioid-related adverse events are most common, and the role of surgeon- and hospital-level factors in contributing to short- and long-term prescription opioid use. Many argue that variation in physician prescribing behavior has been a driver of the opioid epidemic. However, no research has explored the extent to which individual surgeons vary in opioid prescribing following surgery and the implications of that variation for patients’ long-term opioid use and related adverse outcomes. In addition, little research has examined whether intra- and post-operative pain management techniques such as regional anesthesia, which may reduce pain following surgery, may also reduce long-term opioid use and related adverse outcomes after surgery. The proposed research will quantify the short- and long-term effects of opioid prescribing following surgery – including short-term opioid-related adverse events and the transition to long-term use – among previously opioid-naïve older adults who undergo inpatient surgery using Medicare administrative claims. Because a key challenge in identifying the effect of surgeons in contributing to short- and long-term opioid use after hospitalization is separating the effects of provider practice patterns from unobservable patient characteristics that affect opioid use, the proposed research will develop novel quasi-experimental approaches that rely on quasi-random assignment of hospitalized Medicare beneficiaries to providers of varying opioid-prescribing intensity. The proposed research will also develop quasi-experimental methods to study how different approaches to pain management during surgery (use of regional anesthesia) influence post-operative opioid use and potentially downstream opioid-related adverse outcomes. Results from this research will help define the risks of post-operative opioid use among older adults and can inform the need, design and potential impact of policies that target providers to improve the appropriateness of post-surgical opioid prescribing among older adults.

项目概要/摘要 在美国，阿片类药物处方率和阿片类药物相关过量死亡率已翻了两番 过去25年来，这种流行病对老年人的影响越来越大，其中住院率下降了。 从 1993 年到 2012 年，阿片类药物过量增加了五倍 对于老年人来说，使用阿片类药物的风险尤其明显。 尽管人们对阿片类药物的副作用很敏感，但成年人却很容易受到这种副作用的影响。 阿片类药物处方不当，未使用阿片类药物的患者长期使用阿片类药物的方式是 大多数情况下，老年人接受阿片类药物最常见的情况之一是手术后。 手术后的一段时间是阿片类药物特别容易使用的时期，这都是因为老年人的临床脆弱性 手术后，因为出院后的时期通常涉及高度分散的护理过渡。 然而，关于老年人手术后阿片类药物处方量的数据很少， 处方和阿片类药物相关不良事件最常见的手术，以及外科医生的作用 以及医院层面影响短期和长期处方阿片类药物使用的因素。 许多人认为，医生处方行为的变化是阿片类药物流行的一个驱动因素。 然而，没有研究探讨个体外科医生在阿片类药物处方方面的差异程度 手术以及这种变化对患者长期使用阿片类药物和相关不良后果的影响。 此外，很少有研究探讨术中和术后疼痛管理技术是否 因为局部麻醉可以减轻手术后的疼痛，也可以减少阿片类药物的长期使用， 术后相关不良后果。 拟议的研究将量化手术后阿片类药物处方的短期和长期影响 – 包括短期阿片类药物相关不良事件以及向长期使用的过渡 – 之前 使用医疗保险行政索赔接受住院手术的未使用阿片类药物的老年人是一个关键。 确定外科医生对短期和长期阿片类药物使用的影响是一项挑战 住院治疗将提供者实践模式的影响与不可观察的患者特征分开 影响阿片类药物的使用，拟议的研究将开发依赖于阿片类药物使用的新型准实验方法 将住院医疗保险受益人准随机分配给不同阿片类药物处方的提供者 拟议的研究还将开发准实验方法来研究不同的强度。 手术期间的疼痛管理方法（使用区域麻醉）影响术后阿片类药物 使用和潜在的下游阿片类药物相关的不良后果。 这项研究的结果将有助于确定老年人和老年人术后使用阿片类药物的风险 可以告知针对提供商的政策的需求、设计和潜在影响，以改善 老年人术后阿片类药物处方的适当性。