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Postoperative Pain Management Following Orthopedic Spine Procedures and Consequent Acute Opioid Poisoning: An Analysis of New York State From 2009 to 2018.
Kim, Kang Woo; Brodeur, Peter G; Mullen, Marguerite A; Gil, Joseph A; Cruz, Aristides I.
Afiliação
  • Kim KW; The Warren Alpert Medical School of Brown University, Providence, RI.
  • Brodeur PG; The Warren Alpert Medical School of Brown University, Providence, RI.
  • Mullen MA; The Warren Alpert Medical School of Brown University, Providence, RI.
  • Gil JA; Department of Orthopedic Surgery, The Warren Alpert Medical School of Brown University, Providence, RI.
  • Cruz AI; Department of Orthopedic Surgery, The Warren Alpert Medical School of Brown University, Providence, RI.
Spine (Phila Pa 1976) ; 47(18): 1270-1278, 2022 09 15.
Article em En | MEDLINE | ID: mdl-35867612
OBJECTIVE: Considering the high rates of opioid usage following orthopedic surgeries, it is important to explore this in the setting of the current opioid epidemic. This study examined acute opioid poisonings in postoperative spine surgery patients in New York and the rates of poisonings among these patients in the context of New York's 2016 State legislation limiting opioid prescriptions. METHODS: Claims for adult patients who received specific orthopedic spine procedures in the outpatient setting were identified from 2009 to 2018 in the New York Statewide Planning and Research Cooperative System (SPARCS) database. Patients were followed to determine if they presented to the emergency department for acute opioid poisoning postoperatively. Multivariable logistic regression was performed to evaluate the effect of patient demographic factors on the likelihood of poisoning. The impact of the 2016 New York State Public Health Law Section 3331, 5. (b), (c) limiting opioid analgesic prescriptions was also evaluated by comparing rates of poisoning prelegislation and postlegislation enactment. RESULTS: A total of 107,456 spine patients were identified and 321 (0.3%) presented postoperatively to the emergency department with acute opioid poisoning. Increased age [odds ratio (OR)=0.954, P <0.0001] had a decreased likelihood of poisoning. Other race (OR=1.322, P =0.0167), Medicaid (OR=2.079, P <0.0001), Medicare (OR=2.9, P <0.0001), comorbidities (OR=3.271, P <0.0001), and undergoing multiple spine procedures during a single operative setting (OR=1.993, P <0.0001) had an increased likelihood of poisoning. There was also a significant reduction in rates of postoperative acute opioid poisoning in patients receiving procedures postlegislation with reduced overall likelihood (OR=0.28, P <0.0001). CONCLUSION: There is a higher than national average rate of acute opioid poisonings following spine procedures and increased risk among those with certain socioeconomic factors. Rates of poisonings decreased following a 2016 legislation limiting opioid prescriptions. It is important to define factors that may increase the risk of postoperative opioid poisoning to promote appropriate management of postsurgical pain.
Assuntos

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Procedimentos Ortopédicos / Analgésicos Opioides Tipo de estudo: Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Aged / Humans País como assunto: America do norte Idioma: En Ano de publicação: 2022 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Procedimentos Ortopédicos / Analgésicos Opioides Tipo de estudo: Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Aged / Humans País como assunto: America do norte Idioma: En Ano de publicação: 2022 Tipo de documento: Article