Original Research
Sunday, November 12, 2023
12:45 PM–02:15 PM
Abstract
Introduction: The Center for Disease Control (CDC) published their first chronic use opioid guideline in March 2016; Minnesota published their first guideline recommending a maximum of 200 total MME for most invasive surgeries in March 2018. However, impacts of these guidelines on high MME prescribing at post-surgical discharge is unclear.
Research Question or Hypothesis: We hypothesized that the Minnesota opioid guideline would be associated with a greater decrease in high total MME prescribing than the national CDC opioid guideline in a Minnesota health system.
Study Design: A retrospective interrupted time series analysis of multiple treatment periods.
Methods: Electronic health records were aggregated from an integrated academic health system in Minnesota from 2012 to 2019. Adult patients who had undergone their first surgery and discharged with opioids were identified. Segmented linear regression analysis with Newey-West standard errors was conducted to compare the immediate and sustained effects of guidelines on the quarterly prescribing rate of high MME (>200 total MME).
Results: 164,550 patients were identified. The prescribing rate of high MME declined from 57.6% in 2012q1 to 25.3% in 2019q3. The release of the CDC guideline led to an immediate decrease of 1.6% (p=0.373), with a quarterly decline of 1.8% (p=0.003). The second intervention period, corresponding to the release of the Minnesota guideline, resulted in an immediate reduction of 9.2% (p<0.001), followed by a quarterly decline of 2.2% (p<0.001). Compared to the CDC guideline, the Minnesota guideline demonstrated a significantly larger immediate effect on high MME prescribing, with additional reductions of 7.6% (p=0.008). However, the additional sustained effect on slope was not statistically different (0.4%, p=0.367).
Conclusion: The prescribing rate of high MME at post-surgical discharge trended down after publication of 2016 CDC opioid guideline and decreased more steeply after release of 2018 Minnesota opioid guideline, while maintaining a similar trend in slope.
Presenting Author
Yu-Chia Hsu MSc., PharmD, PhD CandidateUniversity of Minnesota
Authors
Genevieve Melton MD, PhD
University of Minnesota School of Medicine
Paul Drawz MD, MHS, MS
University of Minnesota
Joel Farley PhD
University of Minnesota
Christopher Tignanelli MD, MS
University of Minnesota School of Medicine
Eric Weinhandl PhD
University of Minnesota
Rui Zhang PhD
University of Minnesota College of Pharmacy
Bronwyn Southwell MD
University of Minnesota
Wendy St. Peter Pharm.D.
University of Minnesota College of Pharmacy