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Reduction in Opioid Prescribing Through Evidence-Based Prescribing Guidelines

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rarily stopped in preparation for surgery and were therefore excluded from the study. The remaining 93 patients continued their normal AT regimen through surgery. There were 69 patients taking aspirin,… Click to show full abstract

rarily stopped in preparation for surgery and were therefore excluded from the study. The remaining 93 patients continued their normal AT regimen through surgery. There were 69 patients taking aspirin, 7 taking warfarin, 9 taking clopidogrel, 1 taking dabigatran, 3 taking warfarin plus aspirin, and 4 taking dual antiplatelet therapy. Patients treated with AT agents were older than the control group (mean, 66.1 years vs 56.9 years; P < .001). They were also more likely to be male (96.8% vs 84.4%; P = .002), diabetic (55.9% vs 22.9%; P < .001), and nonsmokers (82.8% vs 71.7%; P = .04). Average preoperative median nerve motor latencies at the wrist did not differ significantly between the AT user and non-AT user groups (6.9 milliseconds vs 6.7 milliseconds; P = .44), nor did the rate of intraoperative tourniquet use (32% vs 56% for AT user and nonuser groups, respectively; P = .22). Estimated blood loss was higher in the no-tourniquet group for both AT users (4.33 mL vs 3.22 mL; P = .02) and non-AT users (4.21 mL vs 3.13 mL; P = .006). Mean operating time was shorter in the no-tourniquet group for both those treated with AT agents (20.1 minutes vs 25.7 minutes; P = .001) and those not treated with AT agents (22.40 minutes vs 24.52 minutes; P = .13). There was no statistical difference in EBL (3.94 mL vs 3.89 mL; P = .87) or operative time (22.0 minutes vs 23.0 minutes; P = .38) in AT and non-AT patient groups overall. Rates of postoperative complications were similar between the AT group and the non-AT group (5.4% vs 4.9%; P > .99). No hematomas or neurological complications were reported, and no patients required reoperation during the study period. Overall, 91.8% of patients reported improvement of symptoms postoperatively, with a mean follow-up time of 3.3 months (Table).

Keywords: treated agents; opioid prescribing; group; reduction opioid; prescribing evidence; minutes minutes

Journal Title: JAMA Surgery
Year Published: 2018

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