Department of Surgery, University of Rochester Medical Center, Rochester, NY.
Ann Surg. 2021 Aug 1;274(2):e143-e149. doi: 10.1097/SLA.0000000000003443.
The opioid epidemic has stimulated initiatives to reduce the number of unnecessary narcotic prescriptions. We adopted an opt-in prescription system for patients undergoing ambulatory cervical endocrine surgery (CES). We hypothesized that empowering patients to decide whether or not to receive narcotics for pain control would result in fewer unnecessary opioid prescriptions.
We enrolled all patients scheduled for outpatient CES between July 2017 and June 2018 in a narcotic opt-in program. Patient demographics, procedure characteristics, and postoperative pain scores were collected prospectively. Statistical analyses were performed to correlate clinical predictors with narcotic request. Results were compared against a historical control group. The study was approved by the University IRB.
A total of 216 consecutive patients underwent outpatient CES following implementation of the program. Only nine (4%) requested prescription narcotic medication at discharge, and no patient called after discharge to request analgesic medications. Compared with our prior treatment paradigm, we achieved a 96.6% reduction in the number of narcotic tablets prescribed, and a 98% reduction in unconsumed tablets. Univariate analysis suggested history of substance abuse (P < 0.001), anxiety (P = 0.01), depression (P < 0.001), baseline narcotic use (P = 0.004), highest pain postoperatively (P = 0.004), and incision length (P = 0.007) as predictive for narcotic request. Multivariate analysis retained significance with incision length and history of substance abuse.
By empowering patients undergoing ambulatory CES to accept or decline a prescription, we reduced the number of prescribed narcotic tablets by 96.6%. Although longer incisions and prior substance abuse predict higher likelihood of requesting pain medication on discharge, 207 of 216 patients were treated with acetaminophen alone.
阿片类药物泛滥刺激了减少不必要麻醉性处方数量的措施的出台。我们对接受门诊颈椎内分泌手术（CES）的患者采用了一种选择加入的处方系统。我们假设，赋予患者决定是否接受麻醉性镇痛药控制疼痛的权利，将导致不必要的阿片类药物处方减少。
我们将 2017 年 7 月至 2018 年 6 月期间所有接受门诊 CES 的患者纳入麻醉性药物选择加入计划。前瞻性收集患者的人口统计学、手术特征和术后疼痛评分。我们进行了统计学分析，以将临床预测因素与麻醉性药物请求相关联。结果与历史对照组进行了比较。该研究得到了大学 IRB 的批准。
在实施该计划后，共有 216 例连续患者接受了门诊 CES。只有 9 例（4%）在出院时要求开具处方麻醉性药物，并且没有患者在出院后打电话要求止痛药。与我们之前的治疗模式相比，我们开具的麻醉性药物片剂数量减少了 96.6%，未消耗的片剂减少了 98%。单因素分析表明，滥用药物史（P < 0.001）、焦虑（P = 0.01）、抑郁（P < 0.001）、基线麻醉性药物使用（P = 0.004）、术后最高疼痛（P = 0.004）和切口长度（P = 0.007）是预测麻醉性药物请求的因素。多因素分析保留了切口长度和滥用药物史的意义。
通过赋予接受门诊 CES 的患者接受或拒绝处方的权利，我们将麻醉性药物处方的数量减少了 96.6%。尽管较长的切口和既往药物滥用预测了更高的出院时请求止痛药的可能性，但在 216 例患者中，有 207 例仅接受了对乙酰氨基酚治疗。
