The Use of Novel Linked Databasesto Reduce Postoperative Opioid Use Among Patients Undergoing Inpatient Surgery

使用新型链接数据库减少住院手术患者术后阿片类药物的使用

• 批准号: 10745607
• 负责人: Douglas Alastair Colquhoun
• 金额: $ 110.55万
• 依托单位: STANFORD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10745607
• 关键词: Adverse event; Affect; Agreement; Anesthesia procedures; Caring; Cessation of life; Clinical; Clinical Trials; Computerized Medical Record; Consensus; Data; Data Set; Decision Making; Effectiveness; Elderly; Ensure; Fee-for-Service Plans; Goals; Guidelines; Health; Health Personnel; Healthcare; Healthcare Systems; Helping to End Addiction Long-term; Incidence; Inpatients; Institution; Intervention; Knowledge; Length of Stay; Level of Evidence; Light; Link; Measures; Medicare; Methods; Modality; Morbidity - disease rate; Nerve Block; Observational Study; Operative Surgical Procedures; Opioid; Outcome; Outcome Measure; Overdose; Pain management; Patients; Perioperative; Perioperative Care; Phase; Policies; Postoperative Pain; Postoperative Period; Procedures; Process; Registries; Research; Risk; Risk Reduction; Sample Size; Secure; Surgical Management; System; Time; United States; Work; beneficiary; clinical practice; electronic data; follow-up; improved; inpatient surgery; interest; mortality; non-opioid analgesic; novel; opioid overdose; opioid sparing; opioid use; opioid use disorder; prevent; tool

PROJECT SUMMARY AND ABSTRACT Surgery places patients at increased for opioid use disorder and persistent postoperative opioid use (PPOU). In addition to its direct impact on patient health, PPOU, which affects 5-6% of surgical patients, is associated with an increased risk of opioid use disorder, opioid overdose, and surgical mortality/morbidity. This issue has particular salience for older adults. Over half of all surgical procedures in the United States occur among older adults, over half of older adults will require a surgery once in their lifetime, and the incidence of PPOU among older adults can be as high as 10%. In this light, the long-term goal of this project is to characterize the effectiveness of perioperative interventions in reducing the risk of long-term outcomes such as PPOU and opioid use disorder among older adults undergoing inpatient surgery. While a wide variety of interventions has been hypothesized to reduce the incidence of PPOU and other post-operative opioid outcomes, there remains a lack of consensus about their effectiveness, in part due to data limitations. In particular, it is often challenging to obtain detailed data on perioperative care (i.e., amount of opioid administered intraoperatively) and data on long-term opioid outcomes. This study builds on a novel dataset that links two datasets: the Multicenter Perioperative Outcomes Group (MPOG), a large, multicenter registry of surgical cases using data extracted from electronic medical records and a healthcare claims data for Medicare fee-for-service patients. This novel dataset unites the best aspects of both datasets: the ability to measure perioperative care and the ability to follow patients in order to assess long-term opioid outcomes. We will accomplish the goals of the project through four specific aims. First, we will augment the existing dataset by developing scalable and generalizable tools to incorporate relevant data from the inpatient stay (i.e. opioid administration and the use of non-opioid adjuncts). Second, we will demonstrate the feasibility of these methods at a single institution and expand their use to five institutions. Third, we will use the augmented dataset to evaluate the association between intraoperative interventions (i.e., opioid administration, use of nerve blocks) and long-term opioid outcomes (i.e., PPOU and opioid use disorder). Finally, we will use the augmented dataset to evaluate the association between inpatient stay interventions (i.e., reduced opioid utilization, reduced prescribing at discharge) and long-term opioid outcomes. The findings of this project will be significant as they will help guide crucial aspects of perioperative decision-making such as intraoperative and postoperative opioid administration. The expected outcomes of this project are relevant to the goals of the HEAL Initiative as they will enhance efforts to reduce the incidence of PPOU and other long-term opioid outcomes such as opioid use disorder. Crucially, throughout the project, we will work with stakeholders to maximize its impact, such as consulting with stakeholders to decide the interventions to study and working with stakeholders to incorporate the project findings into clinical guidelines and policy.

项目概要和摘要 手术使患者阿片类药物使用障碍和术后持续阿片类药物使用 (PPOU) 增加。 除了对患者健康有直接影响外，影响 5-6% 手术患者的 PPOU 还与 阿片类药物使用障碍、阿片类药物过量和手术死亡率/发病率的风险增加。这个问题有 对于老年人尤其突出。在美国，超过一半的外科手术发生在老年人中 成年人中，超过一半的老年人一生中需要进行一次手术，并且 PPOU 的发生率 老年人的比例可能高达 10%。有鉴于此，该项目的长期目标是表征 围手术期干预措施在降低 PPOU 等长期结果风险方面的有效性 接受住院手术的老年人中阿片类药物使用障碍。尽管采取了多种干预措施 假设可以减少 PPOU 和其他术后阿片类药物结局的发生率，但仍然存在 部分由于数据限制，对其有效性缺乏共识。特别是，它常常具有挑战性 获取围手术期护理的详细数据（即术中阿片类药物的用量）和相关数据 长期阿片类药物的结果。这项研究建立在一个链接两个数据集的新颖数据集上：多中心 围手术期结果组 (MPOG)，使用提取的数据进行手术病例的大型多中心登记 来自医疗保险按服务收费患者的电子病历和医疗保健索赔数据。这部小说 数据集结合了两个数据集的最佳方面：衡量围手术期护理的能力和 跟踪患者以评估阿片类药物的长期疗效。我们将完成该项目的目标 通过四个具体目标。首先，我们将通过开发可扩展和可扩展的数据集来扩充现有数据集 整合住院期间相关数据的通用工具（即阿片类药物的管理和使用） 非阿片类药物辅助剂）。其次，我们将在单个机构和机构中展示这些方法的可行性 将其使用范围扩大到五个机构。第三，我们将使用增强数据集来评估关联性 术中干预（即阿片类药物给药、使用神经阻滞）和长期阿片类药物之间的比较 结果（即 PPOU 和阿片类药物使用障碍）。最后，我们将使用增强数据集来评估 住院干预措施之间的关联（即减少阿片类药物的使用、减少在 放电）和长期阿片类药物的结果。该项目的研究结果将具有重要意义，因为它们将有助于指导 围手术期决策的关键方面，例如术中和术后阿片类药物 行政。该项目的预期成果与 HEAL Initiative 的目标相关，因为它们 将加大力度减少 PPOU 和其他长期阿片类药物后果（例如阿片类药物使用）的发生率 紊乱。至关重要的是，在整个项目中，我们将与利益相关者合作，最大限度地发挥其影响，例如 与利益相关者协商，决定要研究的干预措施，并与利益相关者合作，将其纳入 将项目结果转化为临床指南和政策。