Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada.
JAMA Surg. 2020 May 1;155(5):420-429. doi: 10.1001/jamasurg.2019.5875.
The prescription of opioids at discharge after abdominopelvic surgery is variable and often excessive. A lack of guidance for abdominopelvic surgeons may explain the suboptimal nature of current prescribing practices.
To systematically review existing recommendations on the prescription of opioids at discharge, the appropriate disposal of opioids, and the prevention of chronic postsurgical opioid use after abdominopelvic surgery.
This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. From January 2010 to December 2018, a search of MEDLINE, PsycINFO, HealthSTAR, Embase, and the difficult to locate and unpublished (ie, gray) literature was performed using a peer-reviewed strategy with variations of the terms opioid, surgery, and guideline to identify English-language documents that contained recommendations published by professional societies or health care institutions. The quality of clinical practice guidelines was assessed using the Appraisal of Guidelines Research and Evaluation II (AGREE II) tool. A descriptive synthesis of results was performed.
Of 5530 citations screened, 41 full-text documents were included in the systematic review. Fifteen clinical practice guidelines were identified. AGREE II domain scores varied substantially. Identified among the 41 included documents were 98 recommended interventions for the prescription of opioids at discharge, 8 interventions for the disposal of opioids, and 8 interventions for the prevention of chronic postsurgical opioid use. Only 13 of 114 interventions (11.4%) were supported by an assessment of strength or level of evidence, and the amount of opioid recommended after specific abdominopelvic surgical procedures varied widely between guidance documents, even for the same procedure.
Current guidance for the prescription of opioids at discharge after abdominopelvic surgery is heterogeneous and rarely supported by evidence. More research is needed on this topic to guide the development of future recommendations.
腹盆腔手术后出院时开具阿片类药物的处方存在差异，且往往过量。腹盆腔外科医生缺乏指导可能是当前处方实践不尽人意的原因。
系统评价关于腹盆腔手术后出院时开具阿片类药物处方、阿片类药物的适当处置以及预防慢性术后阿片类药物使用的现有建议。
本系统评价遵循《系统评价和荟萃分析的首选报告项目》（PRISMA）指南。从 2010 年 1 月至 2018 年 12 月，使用经过同行评审的策略，对 MEDLINE、PsycINFO、HealthSTAR、Embase 以及难以定位和未发表的（即灰色）文献进行了搜索，该策略对术语阿片类药物、手术和指南进行了各种变体，以确定包含专业协会或医疗机构发布的建议的英文文献。使用评估指南研究和评价 II 工具（AGREE II）评估临床实践指南的质量。对结果进行描述性综合。
在筛选出的 5530 条引文中有 41 篇全文文献纳入系统评价。确定了 15 项临床实践指南。AGREE II 域评分差异很大。在纳入的 41 篇文献中，确定了 98 项用于出院时开具阿片类药物处方的推荐干预措施、8 项用于处置阿片类药物的干预措施以及 8 项用于预防慢性术后阿片类药物使用的干预措施。在 114 项干预措施中，只有 13 项（11.4%）得到了强度或证据水平的评估，而且在不同的指南中，即使对于相同的手术，特定腹盆腔手术后推荐的阿片类药物数量也存在很大差异。
目前关于腹盆腔手术后出院时开具阿片类药物处方的指南存在异质性，且很少有证据支持。需要对这一主题进行更多研究，以指导未来建议的制定。
