Variability in opioid prescribing practices among cardiac surgeons and trainees.
Analgesics, Opioid
/ administration & dosage
Canada
/ epidemiology
Cardiac Surgical Procedures
Female
Humans
Male
Opioid-Related Disorders
/ epidemiology
Pain Management
/ methods
Pain, Postoperative
/ drug therapy
Patient Discharge
Practice Patterns, Physicians'
/ statistics & numerical data
Prescriptions
/ statistics & numerical data
Substance-Related Disorders
/ epidemiology
Surgeons
Surveys and Questionnaires
Training Support
analgesic
cardiovascular research
opioid prescription
Journal
Journal of cardiac surgery
ISSN: 1540-8191
Titre abrégé: J Card Surg
Pays: United States
ID NLM: 8908809
Informations de publication
Date de publication:
Oct 2020
Oct 2020
Historique:
pubmed:
29
7
2020
medline:
1
12
2020
entrez:
29
7
2020
Statut:
ppublish
Résumé
The opioid epidemic has become a major public health crisis in recent years. Discharge opioid prescription following cardiac surgery has been associated with opioid use disorder; however, ideal practices remain unclear. Our aim was to examine current practices in discharge opioid prescription among cardiac surgeons and trainees. A survey instrument with open- and closed-ended questions, developed through a 3-round Delphi method, was circulated to cardiac surgeons and trainees via the Canadian Society of Cardiac Surgeons. Survey questions focused on routine prescription practices including type, dosage and duration. Respondents were also asked about their perceptions of current education and guidelines surrounding opioid medication. Eighty-one percent of respondents reported prescribing opioids at discharge following routine sternotomy-based procedures, however, there remained significant variability in the type and dose of medication prescribed. The median (interquartile range) number of pills prescribed was 30 (20-30) with a median total dose of 135 (113-200) Morphine Milligram Equivalents. Informal teaching was the most commonly reported primary influence on prescribing habits and a lack of formal education regarding opioid prescription was associated with a higher number of pills prescribed. A majority of respondents (91%) felt that there would be value in establishing practice guidelines for opioid prescription following cardiac surgery. Significant variability exists with respect to routine opioid prescription at discharge following cardiac surgery. Education has come predominantly from informal sources and there is a desire for guidelines. Standardization in this area may have a role in combatting the opioid epidemic.
Sections du résumé
BACKGROUND AND AIM
OBJECTIVE
The opioid epidemic has become a major public health crisis in recent years. Discharge opioid prescription following cardiac surgery has been associated with opioid use disorder; however, ideal practices remain unclear. Our aim was to examine current practices in discharge opioid prescription among cardiac surgeons and trainees.
METHODS
METHODS
A survey instrument with open- and closed-ended questions, developed through a 3-round Delphi method, was circulated to cardiac surgeons and trainees via the Canadian Society of Cardiac Surgeons. Survey questions focused on routine prescription practices including type, dosage and duration. Respondents were also asked about their perceptions of current education and guidelines surrounding opioid medication.
RESULTS
RESULTS
Eighty-one percent of respondents reported prescribing opioids at discharge following routine sternotomy-based procedures, however, there remained significant variability in the type and dose of medication prescribed. The median (interquartile range) number of pills prescribed was 30 (20-30) with a median total dose of 135 (113-200) Morphine Milligram Equivalents. Informal teaching was the most commonly reported primary influence on prescribing habits and a lack of formal education regarding opioid prescription was associated with a higher number of pills prescribed. A majority of respondents (91%) felt that there would be value in establishing practice guidelines for opioid prescription following cardiac surgery.
CONCLUSIONS
CONCLUSIONS
Significant variability exists with respect to routine opioid prescription at discharge following cardiac surgery. Education has come predominantly from informal sources and there is a desire for guidelines. Standardization in this area may have a role in combatting the opioid epidemic.
Substances chimiques
Analgesics, Opioid
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2657-2662Subventions
Organisme : University of British Columbia Clinician Investigator Program (E.P.)
Informations de copyright
© 2020 Wiley Periodicals LLC.
Références
Hoots BE, Xu L, Kariisa M, et al. 2018 Annual Surveillance Report of Drug-Related Risks and Outcomes, United States. https://www.cdc.gov/. Accessed on October 1, 2018.
Kanouse AB, Compton P. The epidemic of prescription opioid abuse, the subsequent rising prevalence of heroin Use, and the federal response. J Pain Palliat Care Pharmacother. 2015;29(2):102-114. https://doi.org/10.3109/15360288.2015.1037521
Vadivelu N, Kai AM, Kodumudi V, Sramcik J, Kaye AD. The opioid crisis: a comprehensive overview. Curr Pain Headache Rep. 2018;22(3):16. https://doi.org/10.1007/s11916-018-0670-z
Starting on Opioids - Opioid prescribing patterns in Ontario by family doctors, surgeons, and dentists, for people starting to take opioids. http://startingonopioids.hqontario.ca/. Accessed on April 27, 2020.
Levy B, Paulozzi L, Mack KA, Jones CM. Trends in opioid analgesic-prescribing rates by specialty, U.S., 2007-2012. Am J Prev Med. 2015;49(3):409-413. https://doi.org/10.1016/j.amepre.2015.02.020
Kolodny A, Courtwright DT, Hwang CS et al. The prescription opioid and heroin crisis: a public health approach to an epidemic of addiction. Annu Rev Public Health. 2015;36(1):559-574. https://doi.org/10.1146/annurev-publhealth-031914-122957
Brescia AA, Waljee JF, Hu HM et al. Impact of prescribing on new persistent opioid use after cardiothoracic surgery. Ann Thorac Surg. 2019;108(4):1107-1113. https://doi.org/10.1016/j.athoracsur.2019.06.019
Bicket MC, Long JJ, Pronovost PJ, Alexander GC, Wu CL. Prescription opioid analgesics commonly unused after surgery. JAMA Surg. 2017;152(11):1066-1071. https://doi.org/10.1001/jamasurg.2017.0831
Noly P-E, Rubens FD, Ouzounian M et al. Cardiac surgery training in Canada: current state and future perspectives. J Thorac Cardiovasc Surg. 2017;154:998-1005. https://doi.org/10.1016/j.jtcvs.2017.04.010
Canadian Society of Cardiac Surgeons 2019 Annual Report. 2019.
Makary MA, Overton HN, Wang P. Overprescribing is major contributor to opioid crisis. BMJ. 2017;359:4792. https://doi.org/10.1136/bmj.j4792
Guy GP Jr, Zhang K, Bohm MK et al. Vital signs: changes in opioid prescribing in the United States, 2006-2015. Morb Mortal Wkly Rep. 2017;66(26):697-704. https://doi.org/10.15585/mmwr.mm6626a4
Brat GA, Agniel D, Beam A et al. Postsurgical prescriptions for opioid naive patients and association with overdose and misuse: retrospective cohort study. BMJ. 2018;360:j5790. https://doi.org/10.1136/bmj.j5790
Barnett ML, Olenski AR, Jena AB. Opioid-prescribing patterns of emergency physicians and risk of long-term use. N Engl J Med. 2017;376(7):663-673. https://doi.org/10.1056/NEJMsa1610524
Berger I, Strother M, Talwar R et al. National Variation in opioid prescription fills and long-term use in opioid naïve patients after urological surgery. J Urol. 2019;202(5):1036-1043. https://doi.org/10.1097/JU.0000000000000343
Jena AB, Goldman D, Karaca-Mandic P. Hospital prescribing of opioids to medicare beneficiaries. JAMA Intern Med. 2016;176(7):990-997. https://doi.org/10.1001/jamainternmed.2016.2737
Desveaux L, Saragosa M, Kithulegoda N, Ivers NM. Understanding the behavioural determinants of opioid prescribing among family physicians: a qualitative study. BMC Fam Pract. 2019;20(1):59. https://doi.org/10.1186/s12875-019-0947-2
Lee JS, Parashar V, Miller JB, et al.Opioid prescribing after curative-Intent surgery: a qualitative study using the theoretical domains framework. Ann Surg Oncol. 2018;25(7):1843-1851. https://doi.org/10.1245/s10434-018-6466-x
Meisenberg BR, Grover J, Campbell C, Korpon D. Assessment of opioid prescribing practices before and after implementation of a health system intervention to reduce opioid overprescribing. JAMA Netw open. 2018;1(5):e182908. https://doi.org/10.1001/jamanetworkopen.2018.2908
The market for prescription oral solid opioids, 2010 to 2017. http://www.pmprb-cepmb.gc.ca/view.asp?ccid=1417&lang=en. Accessed on June 22, 2020.
Overton HN, Hanna MN, Bruhn WE, et al.Opioid-prescribing guidelines for common surgical procedures: an expert panel consensus. J Am Coll Surg. 2018;227(4):411-418. https://doi.org/10.1016/J.JAMCOLLSURG.2018.07.659