Park Ko Un, Kyrish Kristin, Terrell John, Yi Min, Caudle Abigail S, Hunt Kelly K, Kuerer Henry M, Bedrosian Isabelle, Thompson Alastair, DeSnyder Sarah M
Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
J Surg Oncol. 2019 Jun;119(7):909-915. doi: 10.1002/jso.25395. Epub 2019 Feb 8.
Few guidelines exist for an opioid prescription after breast surgical oncology (BSO) procedures. We sought to characterize opioid prescribing and use patterns by surgery type.
Patients (n = 332) undergoing BSO procedure were surveyed one week postoperatively for opioid use. The surgeons were surveyed about pain management preferences surgery type. CPT codes were collected for 2017 to calculate the amount of opioids used by surgery type relative to surgeon preference.
Mean oral morphine equivalent (OME) preferred prescription for surgeons who did not tailor prescriptions by surgery type (n = 7, group A) was 177, whereas for those who did tailor (n = 10, group B) varied from 137 to 257 OME. There was a significant difference in opioid use by surgery type: 32 OME for segmental mastectomy (SM) ± sentinel lymph node dissection (SLND), 63 for SM + axillary lymph node dissection (ALND), 76 for total mastectomy (TM) ± SLND, 115 for TM + ALND (P < 0.001). Considering the type of surgeries performed group A prescribers would have 229190 unused OME and group B would have 230826 in 1 year.
Wide variation in opioid use by BSO procedure type was noted with substantial unused OME regardless ofprescribing preference. Evidence-based guidelines are needed to tailor analgesic prescriptions according to the need.
关于乳腺外科肿瘤手术（BSO）后阿片类药物处方的指南很少。我们试图按手术类型描述阿片类药物的处方和使用模式。
对接受BSO手术的患者（n = 332）术后一周进行阿片类药物使用情况调查。对外科医生进行关于疼痛管理偏好和手术类型的调查。收集2017年的现行程序编码（CPT），以计算相对于外科医生偏好的不同手术类型所使用的阿片类药物量。
对于未根据手术类型调整处方的外科医生（n = 7，A组），平均口服吗啡当量（OME）的首选处方为177，而对于那些进行调整的医生（n = 10，B组），OME从137到257不等。不同手术类型的阿片类药物使用存在显著差异：保乳手术（SM）±前哨淋巴结活检（SLND）为32 OME，SM +腋窝淋巴结清扫（ALND）为63，全乳切除术（TM）±SLND为76，TM + ALND为115（P < 0.001）。考虑到所进行的手术类型，A组处方医生在1年内会有229190 OME未使用，B组会有230826 OME未使用。
注意到BSO手术类型的阿片类药物使用差异很大，无论处方偏好如何都有大量未使用的OME。需要基于证据的指南来根据需求调整镇痛处方。
