Rothenberg Kara A, Huyser Michelle R, Edquilang Joanne K, Cureton Elizabeth L, Kwan Rita O, Peng Peter D, Svahn Jonathan D, Shim Veronica
Department of Surgery, University of California San Francisco-East Bay, Oakland, CA.
Department of Surgery, Kaiser Permanente, Oakland, CA.
Perm J. 2019;23. doi: 10.7812/TPP/18-127.
Surgeons write 1.8% of all prescriptions and 9.8% of all opioid prescriptions. Even small doses prescribed for short-term use can lead to abuse; thus, surgeons are uniquely able to combat the opioid epidemic by changing prescribing practices. As part of a department wide quality improvement project, we initiated a nonopioid protocol for all patients undergoing ambulatory breast surgery.
To determine the feasibility of a nonopioid protocol for patients undergoing ambulatory breast surgery and to determine if patient-related factors contribute to surgeon adherence to a nonopioid protocol in ambulatory breast surgery.
Retrospective chart review of a prospectively collected database, with χ analysis and a multiple logistic regression model with the surgeon as the random effect.
Protocol adherence.
A total of 180 patients, with a median age of 63 years (range = 18-95 years), were included. Of these, 127 (70.6%) did not receive opioids; in this group there were 2 hematomas (1.6%), and 3 patients required an opioid prescription (2.4%). Fifty-three (29.4%) were prescribed opioids against protocol; in this group, there was 1 hematoma (1.9%). The operating surgeon was the only variable independently correlated with protocol adherence (p < 0.0001). Age, race/ethnicity, surgery type, and history of long-term opioid use were not.
Ambulatory breast surgery patients tolerated a nonopioid pain regimen well. Surgeons' decisions, rather than patient characteristics, primarily drove the choice of pain management in our study. We believe our protocol can be improved with stricter implementation and education, which must be balanced with practitioner independence.
外科医生开具的处方占所有处方的1.8%，开具的阿片类药物处方占所有阿片类药物处方的9.8%。即使是短期使用的小剂量药物也可能导致滥用；因此，外科医生有独特的能力通过改变处方习惯来对抗阿片类药物流行。作为全科室质量改进项目的一部分，我们为所有接受门诊乳房手术的患者启动了一项非阿片类药物方案。
确定非阿片类药物方案在门诊乳房手术患者中的可行性，并确定患者相关因素是否有助于外科医生在门诊乳房手术中遵循非阿片类药物方案。
对前瞻性收集的数据库进行回顾性图表审查，采用χ分析和以外科医生为随机效应的多元逻辑回归模型。
方案依从性。
共纳入180例患者，中位年龄63岁（范围=18 - 95岁）。其中，127例（70.6%）未接受阿片类药物；该组有2例血肿（1.6%），3例患者需要开具阿片类药物处方（2.4%）。53例（29.4%）违反方案开具了阿片类药物；该组有1例血肿（1.9%）。手术医生是与方案依从性独立相关的唯一变量（p < 0.0001）。年龄、种族/民族、手术类型和长期使用阿片类药物史则无关。
门诊乳房手术患者对非阿片类疼痛治疗方案耐受性良好。在我们的研究中，主要是外科医生的决策而非患者特征驱动了疼痛管理的选择。我们认为，通过更严格的实施和教育可以改进我们的方案，同时必须与从业者的独立性相平衡。
