Department of Surgery, Mount Sinai Hospital, New York, NY, USA; Department of Environmental Medicine and Public Health, Mount Sinai Hospital, New York, NY, USA.
Department of Surgery, Mount Sinai Hospital, New York, NY, USA.
Am J Surg. 2019 Apr;217(4):613-617. doi: 10.1016/j.amjsurg.2018.11.047. Epub 2018 Dec 8.
Recent data has demonstrated that postoperative patients are at risk of chronic opioid abuse. It is unknown whether surgeon postoperative opioid prescribing changed as the opioid crisis entered its peak.
The Institutional Data Warehouse was queried to identify patients who underwent three common elective ambulatory procedures between 2014 and 2018 (n = 3495), including: laparoscopic cholecystectomy, laparoscopic inguinal hernia repair (IHR), and open IHR. The main outcome of interest was opioid pills prescribed, converted to an equianalgesic pill number (1 pill = 5 mg oxycodone).
Postoperative opioid prescribing was stable from 2014 to 2016 then decreased significantly in 2017 and 2018 (p < 0.0001). While the median number of pills prescribed remained stable at 30 between 2014 and 2018, the frequency of patients receiving 30 pills decreased significantly. Multivariate analysis demonstrated significantly fewer pills prescribed postoperatively after 2016.
Reductions in postoperative pills prescribed over time as the opioid crisis worsened suggests that surgeons may be considering the potential for opioid abuse and diversion. Persistently high median number of pills prescribed and continued variation in number of pills prescribed suggests room for further improvement.
最近的数据表明，术后患者存在慢性阿片类药物滥用的风险。尚不清楚随着阿片类药物危机达到顶峰，外科医生术后开具阿片类药物的情况是否发生了变化。
通过机构数据仓库查询 2014 年至 2018 年间进行三种常见的门诊择期手术的患者（n=3495），包括：腹腔镜胆囊切除术、腹腔镜腹股沟疝修补术（IHR）和开放 IHR。主要观察结果是开具的阿片类药物丸数，转换为等效镇痛丸数（1 丸=5mg 羟考酮）。
术后阿片类药物的开具从 2014 年到 2016 年保持稳定，然后在 2017 年和 2018 年显著下降（p<0.0001）。虽然 2014 年至 2018 年间开具的药丸中位数保持在 30 不变，但接受 30 丸的患者数量显著减少。多变量分析表明，2016 年后术后开具的药丸明显减少。
随着阿片类药物危机的恶化，术后开具的药丸数量逐渐减少，这表明外科医生可能正在考虑阿片类药物滥用和滥用的可能性。持续较高的药丸中位数和开具药丸数量的持续变化表明仍有进一步改进的空间。
