Importance There is growing evidence that opioids are overprescribed following surgery. Improving prescribing requires understanding factors associated with opioid consumption. Objective To describe opioid prescribing and consumption for a variety of surgical procedures and determine factors associated with opioid consumption after surgery. Design, Setting, and Participants A retrospective, population-based analysis of the quantity of opioids prescribed and patient-reported opioid consumption across 33 health systems in Michigan, using a sample of adults 18 years and older undergoing surgery. Patients were included if they were prescribed an opioid after surgery. Surgical procedures took place between January 1, 2017, and September 30, 2017, and were included if they were performed in at least 25 patients. Exposures Opioid prescription size in the initial postoperative prescription. Main Outcomes and Measures Patient-reported opioid consumption in oral morphine equivalents. Linear regression analysis was used to calculate risk-adjusted opioid consumption with robust standard errors. Results In this study, 2392 patients (mean age, 55 years; 1353 women [57%]) underwent 1 of 12 surgical procedures. Overall, the quantity of opioid prescribed was significantly higher than patient-reported opioid consumption (median, 30 pills; IQR, 27-45 pills of hydrocodone/acetaminophen, 5/325 mg, vs 9 pills; IQR, 1-25 pills; P < .001). The quantity of opioid prescribed had the strongest association with patient-reported opioid consumption, with patients using 0.53 more pills (95% CI, 0.40-0.65; P < .001) for every additional pill prescribed. Patient-reported pain in the week after surgery was also significantly associated with consumption but not as strongly as prescription size. Compared with patients reporting no pain, patients used a mean (SD) 9 (1) more pills if they reported moderate pain and 16 (2) more pills if they reported severe pain (P < .001). Other significant risk factors included history of tobacco use, American Society of Anesthesiologists class, age, procedure type, and inpatient surgery status. After adjusting for these risk factors, patients in the lowest quintile of opioid prescribing had significantly lower mean (SD) opioid consumption compared with those in the highest quintile (5 [2] pills vs 37 [3] pills; P < .001). Conclusions and Relevance The quantity of opioid prescribed is associated with higher patient-reported opioid consumption. Using patient-reported opioid consumption to develop better prescribing practices is an important step in combating the opioid epidemic.

中文翻译：

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阿片类药物处方与手术后阿片类药物消费的关联。

重要性越来越多的证据表明，阿片类药物在手术后处方过多。改善处方需要了解与阿片类药物消费有关的因素。目的描述各种手术方法的阿片类药物处方和食用量，并确定与阿片类药物术后消耗量有关的因素。设计，环境和参与者采用基于人群的回顾性分析，对密歇根州33个卫生系统中处方的阿片类药物的数量和患者报告的阿片类药物的消费进行了分析，使用了18岁及以上成年人的手术样本。如果患者在手术后开了阿片类药物，则将其包括在内。手术程序于2017年1月1日至2017年9月30日之间进行，如果对至少25名患者进行了手术，则包括在内。术后初始处方中的阿片类药物处方量的暴露。主要结果和措施患者报告的阿片类药物口服吗啡当量消费量。线性回归分析用于计算具有可靠标准误差的风险调整后的阿片类药物消费量。结果在本研究中，对12392例手术中的1例进行了2392例患者（平均年龄55岁； 1353例女性[57％]）的治疗。总体而言，开处方的阿片类药物的量明显高于患者报告的阿片类药物的消费量（中位数为30片； IQR：氢可酮/对乙酰氨基酚为27-45片，氢可酮/对乙酰氨基酚为9片； IQR为1-25片； P <.001）。处方的阿片类药物的量与患者报告的阿片类药物的消耗有最强的相关性，患者每增加一剂处方药，患者要多使用0.53片药（95％CI，0.40-0.65； P <.001）。术后一周患者报告的疼痛也与消耗量显着相关，但不如处方量强。与没有疼痛的患者相比，如果患者报告中度疼痛，则平均使用（SD）多9（1）丸；如果报告严重疼痛，则平均使用16（2）（P <.001）。其他重大危险因素包括吸烟史，美国麻醉医师学会等级，年龄，手术类型和住院手术状况。在对这些危险因素进行调整后，最低阿片类药物处方的五分之一患者与最高阿片类药物的平均（SD）阿片类药物摄入量相比有显着降低（5 [2]药对37 [3]药； P <.001）。结论与相关性阿片类药物的处方量与患者报告的阿片类药物消费量增加有关。