Bibliographic Details
| Title: |
The association of multimodal analgesia and high-risk opioid discharge prescriptions in opioid-naive surgical patients. |
| Authors: |
Langnas, Erica1 (AUTHOR) Erica.Langnas@ucsf.edu, Rodriguez-Monguio, Rosa2,3,4 (AUTHOR), Luo, Yanting4 (AUTHOR), Croci, Rhiannon5 (AUTHOR), Dudley, R. Adams6 (AUTHOR), Chen, Catherine L.1,4 (AUTHOR) |
| Source: |
Perioperative Medicine. 12/15/2021, Vol. 10 Issue 1, p1-10. 10p. |
| Subject Terms: |
*PAIN management, *OPIOIDS, *MEDICAL prescriptions, *ACADEMIC medical centers, *COMBINED modality therapy, *HOSPITAL admission & discharge, *ANALGESIA |
| Abstract: |
Background: Opioids and multimodal analgesia are widely administered to manage postoperative pain. However, little is known on how improvements in inpatient pain control are correlated with high-risk (> 90 daily OME) discharge opioid prescriptions for opioid naïve surgical patients. Methods: We conducted a retrospective observational study of adult opioid-naïve patients undergoing surgery from June 2012 through December 2018 at a large academic medical center. We used multivariate logistic regression to assess whether multimodal analgesic drugs consumed in the 24 h prior to discharge was associated with a reduction in high-risk opioid discharge prescriptions. We identified other risk factors for receiving a high-risk discharge opioid prescription. Results: Among the 32,511 patients, 83% of patients were discharged with an opioid prescription. In 2013, 34.1% of patients with a discharge opioid prescription received a high-risk prescription and this declined to 17.7% by 2018. Use of multimodal analgesic agents during the final 24 h of hospitalization increased each year, with over 80% receiving at least one multimodal analgesic agent by 2018. The median OME consumed in the 24 h prior to discharge peaked in 2013 at 31 and steadily decreased to 19.8 by 2018. There was a significant association between the use of acetaminophen in the 24 h prior to discharge and a high-risk prescription at discharge (p < 0.01). OMEs consumed in the 24 h prior to discharge was a significant predictor of receiving a high-risk discharge prescription, even at low doses. Other factors associated with receipt of a high-risk discharge opioid prescription included male gender, race, history of anxiety disorder, and discharge service. Discussion: Use of multimodal analgesia regimens in hospitalized surgical patients in the 24 h prior to hospital discharge increased between 2012 and 2018. Simultaneously, opioid use prior to hospital discharge decreased. Despite these gains, approximately one in five discharge prescriptions was high-risk (> 90 daily OME). In addition, we found that prescribing of discharge opioids above inpatient opioid requirements remains common in opioid naive surgical patients. Conclusion: Providers should account for pre-discharge opioid consumption and use of multimodal analgesia when considering the total and daily OME's that may be appropriate for an individual surgical patient on the discharge opioid prescription. [ABSTRACT FROM AUTHOR] |
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| Database: |
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