Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX.
Ann Surg. 2020 Jul;272(1):163-169. doi: 10.1097/SLA.0000000000003112.
To characterize opioid discharge prescriptions for pancreatectomy patients.
Wide variation in and over-prescription of opioids after surgery contribute to the United States opioid epidemic through persistent use past the postoperative period. Objective strategies guiding discharge opioid prescriptions for oncologic surgery are lacking, and factors driving prescription amount are not fully delineated.
Characteristics of pancreatectomy patients (March 2016-August 2017) were retrospectively abstracted from a prospective database. Discharge opioids prescriptions were converted to oral morphine equivalents (OME). Regression models identified variables associated with discharge OME.
In 158 consecutive patients, median discharge OME was 250 mg (range 0-3950). Discharge OME was labeled "low" (<200 mg) for 33 patients (21%) and "high" (>400 mg) for 38 (24%). Only shorter operative time (odds ratio [OR]-0.14, P = 0.004) and inpatient team (OR-15.39, P < 0.001) were independently associated with low discharge OME. Older age was the only variable associated with high discharge OME. Fifty-seven patients (36%) used zero opioids in the last 24-hours predischarge, yet 52 of 57 (91%) still received discharge opioids. Older age (OR-1.07), grade B/C pancreatic fistula (OR-3.84), and epidural use (OR-3.12) were independently associated with zero last-24-hours OME (all P ≤ 0.040).
The wide variation in discharge opioid prescriptions is heavily influenced by provider routine/bias and not by objective criteria such as last-24-hours OME. Quality improvement strategies could include aggressive weaning protocols to increase the proportion of patients with zero/near-zero last-24-hour OME and limiting prescriptions to a conservative multiplier of the last-24-hour OME.
描述胰腺切除术患者阿片类药物出院处方的特征。
手术后阿片类药物的使用范围广泛且开具过量导致美国阿片类药物泛滥，患者在术后仍持续使用阿片类药物。目前缺乏针对肿瘤手术的出院阿片类药物处方指导的客观策略，也未充分说明处方数量的驱动因素。
回顾性提取 2016 年 3 月至 2017 年 8 月前瞻性数据库中胰腺切除术患者的特征。将出院阿片类药物处方转换为口服吗啡当量（OME）。回归模型确定与出院 OME 相关的变量。
在 158 例连续患者中，中位数出院 OME 为 250mg（范围 0-3950）。33 例（21%）出院 OME 标记为“低”（<200mg），38 例（24%）为“高”（>400mg）。只有手术时间较短（比值比[OR]-0.14，P=0.004）和住院团队（OR-15.39，P<0.001）与低出院 OME 独立相关。年龄较大是与高出院 OME 相关的唯一变量。57 例患者（36%）在出院前最后 24 小时内未使用任何阿片类药物，但 52 例（91%）仍开具出院阿片类药物。年龄较大（OR-1.07）、B/C 级胰瘘（OR-3.84）和硬膜外使用（OR-3.12）与最后 24 小时 OME 零使用独立相关（均 P≤0.040）。
出院阿片类药物处方的广泛差异主要受提供者常规/偏见的影响，而不是最后 24 小时 OME 等客观标准的影响。质量改进策略可包括积极的药物戒断方案，以增加最后 24 小时 OME 零或接近零的患者比例，并将处方限制在最后 24 小时 OME 的保守倍数内。
