Bui Anthony H, Feldman David L, Brodman Michael L, Shamamian Peter, Kaleya Ronald N, Rosenblatt Meg A, D'Angelo Debra, Somerville Donna, Mudiraj Santosh, Kischak Patricia, Leitman I Michael
1Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA.
Hospitals Insurance Company, New York, NY USA.
J Pharm Policy Pract. 2018 May 17;11:9. doi: 10.1186/s40545-018-0138-x. eCollection 2018.
Few guidelines exist on safe prescription of postoperative analgesia to obese patients undergoing ambulatory surgery. This study examines the preferences of providers in the standard treatment of postoperative pain in the ambulatory setting.
Providers from five academic medical centers within a single US city were surveyed from May-September 2015. They were asked to provide their preferred postoperative analgesic routine based upon the predicted severity of pain for obese and non-obese patients. McNemar's tests for paired observations were performed to compare prescribing preferences for obese vs. non-obese patients. Fisher's exact tests were performed to compare preferences based on experience: > 15 years vs. ≤15 years in practice, and attending vs. resident physicians.
A total of 452 providers responded out of a possible 695. For mild pain, 119 (26.4%) respondents prefer an opioid for obese patients vs. 140 (31.1%) for non-obese ( = 0.002); for moderate pain, 329 (72.7%) for obese patients vs. 348 (77.0%) for non-obese ( = 0.011); for severe pain, 398 (88.1%) for obese patients vs. 423 (93.6%) for non-obese ( < 0.001). Less experienced physicians are more likely to prefer an opioid for obese patients with moderate pain: 70 (62.0%) attending physicians with > 15 years in practice vs. 86 (74.5%) with ≤15 years ( = 0.047), and 177 (68.0%) attending physicians vs. 129 (83.0%) residents ( = 0.002).
While there is a trend to prescribe less opioid analgesics to obese patients undergoing ambulatory surgery, these medications may still be over-prescribed. Less experienced physicians reported prescribing opioids to obese patients more frequently than more experienced physicians.
关于为接受门诊手术的肥胖患者安全开具术后镇痛药物的指南很少。本研究调查了医疗服务提供者在门诊环境中对术后疼痛标准治疗的偏好。
2015年5月至9月对美国一个城市内五家学术医疗中心的医疗服务提供者进行了调查。要求他们根据肥胖和非肥胖患者预测的疼痛严重程度，给出他们首选的术后镇痛方案。采用配对观察的McNemar检验来比较肥胖与非肥胖患者的处方偏好。采用Fisher精确检验来比较基于经验的偏好：执业超过15年与执业≤15年，以及主治医师与住院医师。
在可能的695名受访者中，共有452人做出了回应。对于轻度疼痛，119名（26.4%）受访者倾向于为肥胖患者开具阿片类药物，而非肥胖患者为140名（31.1%）（P = 0.002）；对于中度疼痛，肥胖患者为329名（72.7%），非肥胖患者为348名（77.0%）（P = 0.011）；对于重度疼痛，肥胖患者为398名（88.1%），非肥胖患者为423名（93.6%）（P < 0.
