Stepan Jeffrey G, Sacks Hayley A, Lovecchio Francis C, Premkumar Ajay, Fu Michael C, Osei Daniel A, Fufa Duretti T
Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY.
Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY.
J Hand Surg Am. 2019 Feb;44(2):129-136. doi: 10.1016/j.jhsa.2018.06.014. Epub 2018 Jul 19.
Recent studies demonstrated the overprescription of opioids after ambulatory hand surgery in the setting of a national opioid epidemic. Prescriber education has been shown to decrease these practices on a small scale; however, currently no nationally standardized prescriber education or postoperative opioid prescribing guidelines exist. The purpose of this study was to evaluate the effect of prescriber opioid education and postoperative opioid guidelines on prescribing practices after ambulatory hand surgery.
This retrospective study was performed at an academic orthopedic hospital. In November, 2016, all prescribers were mandated to undergo a 1-hour opioid education program. Prescribing guidelines for the hand service were formulated based on literature review and expert opinion and were released in February, 2017. We reviewed all postoperative opioid prescriptions for patients who underwent ambulatory hand and upper-extremity surgery 4 months before the mandatory education (preeducation group) and 4 months (immediate postguideline group) and 9 to 11 months (intermediate postguideline group) after the guideline dissemination.
A total of 1,348 ambulatory hand surgeries (435 in the preeducation, 490 in the immediate postguideline group, and 423 in the intermediate postguidelines groups) with postoperative opioid prescriptions met inclusion criteria. Mean reduction in total prescribed oral morphine equivalents was 52.3% after guidelines disseminated. The number of opioid pills prescribed to patients decreased significantly in the postguideline groups when stratified by procedure type and surgery level.
Prescriber education and postoperative opioid guideline dissemination led to significant decreases in the number of opioid pills prescribed after ambulatory hand surgery. Development and dissemination of nationally standardized prescriber education and opioid guidelines may significantly reduce the amount of opioid medications prescribed after hand surgery.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
近期研究表明，在全国性阿片类药物泛滥的背景下，门诊手部手术后存在阿片类药物过度处方的情况。已证明处方医生教育能在小范围内减少此类行为；然而，目前尚无全国标准化的处方医生教育或术后阿片类药物处方指南。本研究的目的是评估处方医生阿片类药物教育和术后阿片类药物指南对门诊手部手术后处方行为的影响。
本回顾性研究在一家学术性骨科医院进行。2016年11月，所有处方医生都被要求参加一个1小时的阿片类药物教育项目。手部服务的处方指南基于文献综述和专家意见制定，并于2017年2月发布。我们回顾了在强制教育前4个月（教育前组）、指南发布后4个月（指南发布后即刻组）以及指南发布后9至11个月（指南发布后中期组）接受门诊手部和上肢手术患者的所有术后阿片类药物处方。
共有1348例门诊手部手术（教育前组435例，指南发布后即刻组490例，指南发布后中期组423例）的术后阿片类药物处方符合纳入标准。指南发布后，总处方口服吗啡当量平均减少了52.3%。按手术类型和手术级别分层时，指南发布后组患者开具的阿片类药丸数量显著减少。
处方医生教育和术后阿片类药物指南的发布导致门诊手部手术后开具的阿片类药丸数量显著减少。制定和发布全国标准化的处方医生教育和阿片类药物指南可能会显著减少手部手术后阿片类药物的处方量。
研究类型/证据水平：治疗性IV级。
