From the Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School; the American Association for Accreditation of Ambulatory Surgery Facilities; Gary M. Brownstein, M.D., P.C. (private practice); The Reed Center (private practice); and the Plastic and Cosmetic Surgery Institute (private practice).
Plast Reconstr Surg. 2020 Mar;145(3):687-695. doi: 10.1097/PRS.0000000000006570.
The United States is currently in the midst of an opioid epidemic precipitated, in part, by the excessive outpatient supply of opioid pain medications. Accordingly, this epidemic has necessitated evaluation of practice and prescription patterns among surgical specialties. The purpose of this study was to quantify opioid-related adverse events in ambulatory plastic surgery.
A retrospective review of 43,074 patient profiles captured from 2001 to 2018 within an American Association for Accreditation of Ambulatory Surgery Facilities quality improvement database was conducted. Free-text search terms related to opioids and overdose were used to identify opioid-related adverse events. Extracted profiles included information submitted by accredited ambulatory surgery facilities and their respective surgeons. Descriptive statistics were used to quantify opioid-related adverse events.
Among our cohort, 28 plastic surgery patients were identified as having an opioid-related adverse event. Overall, there were three fatal and 12 nonfatal opioid-related overdoses, nine perioperative opioid-related adverse events, and four cases of opioid-related hypersensitivities or complications secondary to opioid tolerance. Of the nonfatal cases evaluated in the hospital (n = 17), 16 patients required admission, with an average 3.3 ± 1.7 days' hospital length of stay.
Opioid-related adverse events are notable occurrences in ambulatory plastic surgery. Several adverse events may have been prevented had different diligent medication prescription practices been performed. Currently, there is more advocacy supporting sparing opioid medications when possible through multimodal anesthetic techniques, education of patients on the risks and harms of opioid use and misuse, and the development of societal guidance regarding ambulatory surgery prescription practices.
美国目前正处于阿片类药物流行之中，部分原因是阿片类止痛药的过度门诊供应。因此，这一流行情况需要对手术专业的实践和处方模式进行评估。本研究的目的是量化门诊整形手术中的阿片类药物相关不良事件。
对美国外科医师学会认证的门诊手术设施质量改进数据库中 2001 年至 2018 年的 43074 名患者资料进行回顾性分析。使用与阿片类药物和过量相关的自由文本搜索词来识别阿片类药物相关不良事件。提取的资料包括经认证的门诊手术设施及其各自外科医生提交的信息。使用描述性统计来量化阿片类药物相关不良事件。
在我们的队列中，有 28 名整形患者被确定为发生阿片类药物相关不良事件。总体而言，有 3 例致命和 12 例非致命的阿片类药物相关过量，9 例围手术期阿片类药物相关不良事件，以及 4 例阿片类药物相关过敏或因阿片类药物耐受引起的并发症。在住院评估的非致命病例中（n = 17），16 名患者需要住院，平均住院时间为 3.3 ± 1.7 天。
阿片类药物相关不良事件在门诊整形手术中是显著的。如果采用不同的谨慎药物处方实践，可能会预防一些不良事件。目前，更多的倡导支持在可能的情况下通过多模式麻醉技术、对患者进行阿片类药物使用和滥用风险和危害的教育以及制定关于门诊手术处方实践的社会指导来减少阿片类药物的使用。
