Tendances de la délivrance d’opioïdes après des interventions courantes de chirurgie abdominale et orthopédique en Colombie-Britannique : une analyse rétrospective de cohorte

Abstract

Purpose Postdischarge opioid prescriptions are reportedly much higher in Canada than in other countries. To assess potentially contributing factors, we examined trends after abdominal and orthopedic surgeries in British Columbia (BC). Methods Using the BC Ministry of Health’s databases on physician billings, hospital discharge abstracts, and medication dispensations in community pharmacies for the period 2003–2016, we assembled a cohort of 263,056 patients who received laparoscopic appendectomy (LA, 11%), laparoscopic cholecystectomy (LC, 30%), open inguinal or femoral hernia repair (IHR, 20%), total hip arthroplasty (THA, 18%), or total knee arthroplasty (TKA, 22%). Adjusting for covariates using generalized linear modeling, we measured trends in percentages of patients dispensed opioids postdischarge (opioid rate) within 30 days after surgery, by surgery type, opioid type, prior use, surgeon, and trends in morphine milligram equivalents of first dispensations (MME) with 95% confidence intervals (CI). Results Opioid dispensation rates rose steadily. Mean annual increases were 1.7% in LA; 1.3% in LC; 0.8% in IHR; 0.9% in THA; and 0.8% in TKA. By 2016, rates were 69% in LA; 76% in LC; 81% in IHR; 88% in THA; and 94% in TKA. Codeine dispensations fell 2.4% (abdominal) and 3.1% (orthopedic) per year while tramadol dispensations increased 3.6% (abdominal) and 1.7% (orthopedic). Hydromorphone dispensations increased 2.9% per year (orthopedic); oxycodone was level at 22% between 2007 and 2014, but then fell. The mean MME rose 8 mg⋅yr -1 (95% CI, 7 to 9) (abdominal) and 61 mg⋅yr -1 (95% CI, 58 to 64) (orthopedic). Variation in rates was greater among abdominal than orthopedic surgeons. Conclusion Rising opioid dispensation rates, together with shifts to prescribing higher MME opioids, doubled MME per patient in first dispensations postdischarge after abdominal or orthopedic surgery from 2003 to 2016 in BC. Supplementary Information The online version contains supplementary material available at 10.1007/s12630-022-02272-7.

Le rôle des anesthésiologistes dans la réduction des préjudices liés aux opioïdes

“…This month's Special Issue of the Journal, dedicated to the topic of opioid analgesia for surgical patients, features an array of studies from across Canada on postoperative opioid prescription patterns, their associations with shortand long-term opioid use, and associated downstream effects. [1][2][3][4][5][6][7] While numerous factors inform perioperative opioid use and the data in these studies speak to a multitude of aspects, we ask what role we, as anesthesiologists, can play in reducing opioid-related harm to patients? Most patients after major surgery have a time-limited course of acute pain that dissipates; however, an unfortunate 5-35% develop severe chronic postsurgical pain (CPSP) that leads to significant pain disability one year after surgery.…”

“…22 Le nume ´ro spe ´cial de ce mois-ci du Journal, consacre ´au sujet de l'analge ´sie opioı ¨de pour les patients chirurgicaux, pre ´sente un e ´ventail d'e ´tudes provenant de partout au Canada sur les tendances de prescription d'opioı ¨des postope ´ratoires, leurs associations avec la consommation d'opioı ¨des a `court et a `long terme, et les effets qui leur sont associe ´s en aval. [1][2][3][4][5][6][7] Bien que de nombreux facteurs e ´clairent l'utilisation pe ´riope ´ratoire d'opioı ¨des et que les donne ´es de ces e ´tudes traitent d'une multitude d'aspects, nous nous demandons quel ro ˆle nous, en tant qu'anesthe ´siologistes, pouvons jouer dans la re ´duction des pre ´judices lie ´s aux opioı ¨des pour les patients.…”