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Surgeon Variation in Perioperative Opioid Prescribing and Medium- or Long-term Opioid Utilization after Total Knee Arthroplasty: A Cross-sectional Analysis.
Anesthesiology ( IF 8.8 ) Pub Date : 2022-08-01 , DOI: 10.1097/aln.0000000000004259
Xi Cen 1 , Anupam B Jena 2 , Sean Mackey 1 , Eric C Sun 1
Affiliation  

BACKGROUND Whether a particular surgeon's opioid prescribing behavior is associated with prolonged postoperative opioid use is unknown. This study tested the hypothesis that the patients of surgeons with a higher propensity to prescribe opioids are more likely to utilize opioids long-term postoperatively. METHODS The study identified 612,378 Medicare fee-for-service patients undergoing total knee arthroplasty between January 1, 2011, and December 31, 2016. "High-intensity" surgeons were defined as those whose patients were, on average, in the upper quartile of opioid utilization in the immediate perioperative period (preoperative day 7 to postoperative day 7). The study then estimated whether patients of high-intensity surgeons had higher opioid utilization in the midterm (postoperative days 8 to 90) and long-term (postoperative days 91 to 365), utilizing an instrumental variable approach to minimize confounding from unobservable factors. RESULTS In the final sample of 604,093 patients, the average age was 74 yr (SD 5), and there were 413,121 (68.4%) females. A total of 180,926 patients (30%) were treated by high-intensity surgeons. On average, patients receiving treatment from a high-intensity surgeon received 36.1 (SD 35.0) oral morphine equivalent (morphine milligram equivalents) per day during the immediate perioperative period compared to 17.3 morphine milligram equivalents (SD 23.1) per day for all other patients (+18.9 morphine milligram equivalents per day difference; 95% CI, 18.7 to 19.0; P < 0.001). After adjusting for confounders, receiving treatment from a high-intensity surgeon was associated with higher opioid utilization in the midterm opioid postoperative period (+2.4 morphine milligram equivalents per day difference; 95% CI, 1.7 to 3.2; P < 0.001 [11.4 morphine milligram equivalents per day vs. 9.0]) and lower opioid utilization in the long-term postoperative period (-1.0 morphine milligram equivalents per day difference; 95% CI, -1.4 to -0.6; P < 0.001 [2.8 morphine milligram equivalents per day vs. 3.8]). While statistically significant, these differences are clinically small. CONCLUSIONS Among Medicare fee-for-service patients undergoing total knee arthroplasty, surgeon-level variation in opioid utilization in the immediate perioperative period was associated with statistically significant but clinically insignificant differences in opioid utilization in the medium- and long-term postoperative periods. EDITOR’S PERSPECTIVE

中文翻译:

全膝关节置换术后围手术期阿片类药物处方和中长期阿片类药物使用的外科医生变化:横断面分析。

背景未知特定外科医生的阿片类药物处方行为是否与术后阿片类药物使用时间延长有关。本研究检验了以下假设:外科医生开具阿片类药物处方倾向较高的患者更有可能在术后长期使用阿片类药物。方法 该研究确定了 612,378 名在 2011 年 1 月 1 日至 2016 年 12 月 31 日期间接受全膝关节置换术的 Medicare 付费服务患者。“高强度”外科医生被定义为患者平均处于上四分之一围手术期(术前第 7 天至术后第 7 天)阿片类药物的使用。然后,该研究评估了高强度外科医生的患者在中期(术后第 8 至 90 天)和长期(术后第 91 至 365 天)是否具有更高的阿片类药物使用率,利用工具变量方法将不可观察因素的混杂因素降至最低。结果 在 604,093 名患者的最终样本中,平均年龄为 74 岁 (SD 5),其中女性为 413,121 名 (68.4%)。共有 180,926 名患者 (30%) 接受了高强度外科医生的治疗。平均而言,接受高强度外科医生治疗的患者在围手术期即刻每天接受 36.1 (SD 35.0) 口服吗啡当量(吗啡毫克当量),而所有其他患者每天接受 17.3 吗啡毫克当量(SD 23.1)( +18.9 吗啡毫克当量/天差异;95% CI,18.7 至 19.0;P < 0.001)。调整混杂因素后,接受高强度外科医生的治疗与中期阿片类药物术后期间更高的阿片类药物利用率相关(+2.4 吗啡毫克当量/天差异;95% CI,1.7 至 3.2;P < 0.001 [11.4 吗啡毫克每天当量 vs. 9.0])和长期术后阿片类药物使用率较低(-1.0 吗啡毫克当量/天差异;95% CI,-1.4 至 -0.6;P < 0.001 [每天 2.8 吗啡毫克当量 vs . 3.8])。虽然具有统计学意义,但这些差异在临床上很小。结论 在接受全膝关节置换术的 Medicare 按服务收费的患者中,围手术期即刻阿片类药物使用的外科医生水平差异与术后中期和长期阿片类药物使用的统计学显着但临床上不显着的差异相关。编辑的观点
更新日期:2022-05-03
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