Department of Surgery, University of Vermont Medical Center, Burlington, VT; University of Vermont Larner College of Medicine, Burlington, VT.
University of Vermont Larner College of Medicine, Burlington, VT.
J Am Coll Surg. 2018 Jun;226(6):1004-1012. doi: 10.1016/j.jamcollsurg.2018.01.058. Epub 2018 Feb 28.
The number of deaths from prescription opioids in the US continues to increase and remains a major public health concern. Opioid-related deaths parallel prescribing trends, and postoperative opioids are a significant source of opioids in the community. Our objective was to identify opioid prescribing and use patterns after surgery to inform evidence-based practices.
Data from a 340-bed academic medical institution and its affiliated outpatient surgical facility included retrospective medical record data and prospective telephone questionnaire and medical record data. Retrospective data included patients discharged after 1 of 19 procedure types, from July 2015 to June 2016 (n = 10,112). Prospective data included a consecutive sample of general and orthopaedic surgery and urology patients undergoing 1 of 13 procedures, from July 2016 to February 2017 (n = 539). Primary outcomes were the quantity of opioid prescribed and used in morphine milligram equivalents (MME), and the proportion of patients receiving instructions on disposal and nonopioid strategies.
In the retrospective dataset, 76% of patients received an opioid after surgery, and 87% of prescriptions were prescribed by residents or advanced practice providers. Median prescription size ranged from 0 to 503 MME, with wide interquartile ranges (IQR) for most procedures. In the prospective dataset, there were 359 participants (67% participation rate). Of these, 92% of patients received an opioid and the median proportion used was 27%, or 24 MME (IQR 0 to 96). Only 18% of patients received disposal instructions, while 84% of all patients received instructions on nonopioid strategies.
Median opioid use after surgery was 27% of the total prescribed, and only 18% of patients reported receiving disposal instructions. Significant variability in opioid prescribing and use after surgery warrants investigation into contributing factors.
美国因处方类阿片致死的人数持续增加，仍是主要的公共卫生关注点。阿片类药物相关死亡与处方趋势一致，术后阿片类药物是社区中阿片类药物的重要来源。我们的目的是确定手术后阿片类药物的开具和使用模式，为循证实践提供信息。
这项来自一家 340 床位的学术医疗机构及其附属门诊手术机构的数据包括回顾性病历数据和前瞻性电话问卷调查及病历数据。回顾性数据包括 2015 年 7 月至 2016 年 6 月期间 19 种手术类型中出院的患者（n=10112）。前瞻性数据包括 2016 年 7 月至 2017 年 2 月期间接受 13 种手术之一的普通外科和骨科以及泌尿科患者的连续样本（n=539）。主要结局指标是开具和使用的吗啡毫克当量（MME）的阿片类药物数量，以及接受处置和非阿片类药物策略指导的患者比例。
在回顾性数据集，76%的患者在手术后接受了阿片类药物，87%的处方由住院医师或高级执业医师开具。中位数处方剂量范围从 0 到 503 MME，大多数手术的四分位间距（IQR）很宽。在前瞻性数据集，有 359 名参与者（参与率为 67%）。其中，92%的患者接受了阿片类药物，中位数使用比例为 27%，即 24 MME（IQR 0 至 96）。只有 18%的患者收到了处置说明，而所有患者中有 84%的患者收到了非阿片类药物策略的说明。
手术后阿片类药物的中位数使用率为总处方量的 27%，只有 18%的患者报告收到了处置说明。手术后阿片类药物的开具和使用存在显著差异，需要调查其影响因素。
