Surgical Outcomes and Quality Improvement Center, Department of Surgery and Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, IL.
Surgical Outcomes and Quality Improvement Center, Department of Surgery and Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Surgery, Rush University Medical Center, Chicago, IL.
Surgery. 2020 May;167(5):852-858. doi: 10.1016/j.surg.2020.01.002. Epub 2020 Feb 20.
Because many patients are first exposed to opioids after general surgery procedures, surgical stewardship for the use of opioids is critical in addressing the opioid crisis. We developed a multi-component opioid reduction program to minimize the use of opioids after surgery. Our objectives were to assess patient exposure to the intervention and to investigate the association with postoperative use and disposal of opioids.
We implemented a multi-component intervention, including patient education, the settings of expectations, the education of the providers, and an in-clinic disposal box in our large, academic, general surgery clinic. From April to December 2018, patients were surveyed by phone 30 to 60 days after their operation regarding their experience with postoperative pain management. The association between patient education and preparedness to manage pain was assessed using χ tests. Education, preparedness, and clinical factors were evaluated for association with quantity of pills used using ANOVA and multivariable linear regression.
Of the 389 eligible patients, 112 responded to the survey (28.8%). Patients receiving both pre and postoperative education were more likely to feel prepared to manage pain than those who only received the education pre or postoperatively (91% vs 68%, P = .01). Patients who felt prepared to manage their pain used 9.1 fewer pills on average than those who did not (P = .01). Fourteen patients (24%) with excess pills disposed of them. Preoperative education was associated with disposal of excess pills (30% vs 0%, P < .05).
Exposure to clinic-based interventions, particularly preoperatively, can increase patient preparedness to manage postoperative pain and decrease the quantity of opioids used. Additional strategies are needed to increase appropriate disposal of unused opioids.
由于许多患者在接受普通外科手术后首次接触到阿片类药物，因此对阿片类药物的使用进行外科管理对于解决阿片类药物危机至关重要。我们制定了一个多组分阿片类药物减少计划，以最大限度地减少手术后阿片类药物的使用。我们的目标是评估患者对干预措施的暴露程度，并研究其与术后使用和处置阿片类药物的关系。
我们在一个大型的学术普通外科诊所实施了多组分干预措施，包括患者教育、设定预期、对医务人员进行教育以及在诊所设置处置箱。在 2018 年 4 月至 12 月期间，对手术后 30 至 60 天的患者进行电话调查，了解他们对术后疼痛管理的体验。使用 χ 检验评估患者教育与准备管理疼痛之间的关系。使用 ANOVA 和多变量线性回归评估教育、准备和临床因素与使用药丸数量的关系。
在 389 名符合条件的患者中，有 112 名患者接受了调查（28.8%）。接受术前和术后教育的患者比仅接受术前或术后教育的患者更有可能感到有准备管理疼痛（91%比 68%，P =.01）。感到有准备管理疼痛的患者平均使用的药丸少 9.1 片（P =.01）。有 14 名患者（24%）处理了多余的药丸。术前教育与处置多余药丸有关（30%比 0%，P <.05）。
接触基于诊所的干预措施，特别是术前干预，可以提高患者管理术后疼痛的准备程度，并减少阿片类药物的使用量。需要采取额外的策略来增加对未使用阿片类药物的适当处置。
