How One State Beat the Nationwide Surgical Opioid Trend

Newswise — A statewide effort to treat pain in surgical patients without increasing the risk of long-term opioid dependence is paying off in Michigan, study shows.

In less than two years, this initiative reduced the amount of opioids taken by patients undergoing six common surgeries by 56%, and the chances of meeting opioid prescriptions months after surgical pain26 % decreased. eased.

Both of these drops are above national trends for similar patients, according to a new study published in . surgical record By a team from Michigan Medicine, an academic medical center at the University of Michigan.

For example, Michigan patients who underwent certain surgeries, such as removing part of the colon, showed the greatest reduction in the amount of opioids they received after surgery during the study period. They also had the lowest risk of developing persistent opioid use. This is defined by the researchers as opioid prescription for months or years after surgery when the initial surgery-related prescription was intended for short-term use.

The Michigan effort used prescribing guidelines based on real-world evidence for the opioid doses surgical patients actually needed to provide pain relief, compared to the prescribed doses.

The important thing is that the guidelines do not cause pain to the patient. In fact, past studies have shown that surgical patients who received low-dose opioid prescriptions had similar pain outcomes and were equally satisfied with their pain care.

“Each year, tens of millions of people undergo surgery in the United States, and most come home with prescriptions for opioid pain relievers, which are intended for short-term use during recovery from surgery. Unfortunately, however, some patients continue to fill their opioid prescriptions months or years after surgery, increasing the risk of opioid use disorders, overdoses, and death. MS, a resident of the United States, said: “Reducing these trends is an important part of addressing our country’s opioid problem.”

Statewide Team Efforts

This work was driven by the Opioid Prescribing Engagement Network and the Michigan Surgical Quality Collaborative, both based in UM, and surgical team leaders from 70 hospitals across the state participating in MSQC and implementing OPEN guidelines.

“Our study shows how voluntary prescribing guidelines and the involvement of the surgical team in selecting evidence-based pain care options can really make a difference.” Anesthesiology. “Reducing the number of opioids prescribed and dispensed means not only a lower risk of continued use, but also a lower risk of unused opioid medication to others in the household.”

Helping patients safely dispose of leftover opioids from home is another important goal of the Opioid Prescription Engagement Network. They offer several free programs to organizations in Michigan, including free drug disposal pouches, permanent disposal boxes, and drug recall event planning materials.

Making Michigan the Safest Surgery Place

By comparing records of tens of thousands of patients who underwent six types of surgery in Michigan with those who underwent surgery in other states, the team found that the decline in Michigan, where these guidelines were implemented, was It showed that it outperformed the United States and other Midwestern states.

Their analysis spans nearly four years before the prescribing guidelines were rolled out statewide, and then nearly two years from 2013 to mid-2019.

They focused on conventional Medicare-eligible patients who had not filled an opioid prescription 1 year before surgery and who had not undergone a second surgery 6 months after index surgery.

The study focused on nearly 25,000 Michigan patients and more than 118,600 non-Michigan patients who underwent minimally invasive cholecystectomy or appendectomy, minor or severe hernia repair, partial colonic Had a resection (colectomy) or hysterectomy.

These six types of surgery were the initial focus in developing and implementing prescribing guidelines based on filling opioid prescriptions and surveying patients undergoing surgery. They were first published in October 2017 and have since been added along with guidelines for other types of surgical and dental procedures. bottom.

The 70 hospitals in Michigan where the guidelines were rolled out account for the majority of surgical care in the state. The non-Michigan patient was his 20% sample of all traditional Medicare patients who underwent the same surgery in the same time frame.

Researchers looked for signs of new and sustained opioid use. This means that the patient dispensed an opioid prescription immediately after surgery and another opioid prescription at least once during the three months following surgery and up to six months after surgery. They also looked at the total amount of opioids patients received during the six months following surgery.

Opioid prescriptions generally trended downward in the mid-2010s, so researchers looked at differences in Michigan and national trends to see if there was a difference.

Michigan Surpasses the US

Michigan patients had a greater reduction in new sustained opioid use than non-Michigan patients, with a difference of approximately 0.5 percentage points between the two drops.

This was due in particular to a 2.76 point decrease in patients undergoing colon surgery and a small but significant decrease in patients undergoing gallbladder and minor hernia surgery. For patients undergoing other surgeries, there was no difference between Michigan and the rest of the United States, or there was a slight increase in appendectomy in Michigan.

Overall, surgical patients in Michigan had a faster reduction in the size of the opioid prescription they filled compared to patients in other states who underwent the same surgery over the same period.

The difference was approximately 56 mg opioid by the end of the study period and was significantly reduced for all types of surgery except laparoscopic appendectomy. Michigan patients started on approximately 200 mg morphine equivalents and decreased on average to 89 mg morphine, whereas non-Michigan patients started on 218 mg morphine and decreased to 154 mg morphine.

Although the magnitude of opioid prescriptions dispensed to surgical patients in Michigan was actually lower than the national surgical opioid prescriptions pre-guideline, sustained postoperative opioid use was 2.7% in Michigan. was as high as 3.4%.

Even when researchers excluded cancer patients and patients with substance problems, Michigan outperformed the rest of the country in reducing sustained use and reducing the volume of prescriptions dispensed to patients. I got

Colon surgery patients in Michigan showed the greatest decline in both the amount of opioids they received and the opportunities for sustained use.

The researchers also further compared Michigan to a group of Midwestern states, Indiana and Wisconsin, in an analysis that excluded cancer patients and those previously diagnosed with substance use disorders. In Case, Michigan performed better than the nation.

Both MSQC and OPEN are funded by Blue Cross Blue Shield of Michigan. The Opioid Prescription Engagement Network is funded by the Michigan Department of Health and Human Services and the National Institutes of Health, and is supported by the UM Healthcare Policy and Innovation Institute.

In addition to Howard and Brummett, the authors of the study are Dr. Andrew Ryan, former UM School of Public Health, and Dr. Hsou Mei Hu, OPEN, MBA. Craig S. Brown, MD, MS, of Surgery; and OPEN co-directors Jennifer Waljee, MD, MPH, MS, Mark Bicket, MD, Ph.D. and Michael Englesbe, MD Many of the authors are IHPI and Center for Healthcare Outcomes and Policy member.

Cited paper: “Evidence-Based Opioid Prescribing Guidelines and New Sustained Opioid Use After Surgery” surgical recordDOI: 10.1097/SLA.0000000000005792

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