Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Ann Surg. 2022 Feb 1;275(2):e361-e365. doi: 10.1097/SLA.0000000000003986.
We compare consensus recommendations for 5 surgical procedures to prospectively collected patient consumption data. To address local variation, we combined data from multiple hospitals across the country.
One approach to address the opioid epidemic has been to create prescribing consensus reports for common surgical procedures. However, it is unclear how these guidelines compare to patient-reported data from multiple hospital systems.
Prospective observational studies of surgery patients were completed between 3/2017 and 12/2018. Data were collected utilizing post-discharge surveys and chart reviews from 5 hospitals (representing 3 hospital systems) in 5 states across the USA. Prescribing recommendations for 5 common surgical procedures identified in 2 recent consensus reports were compared to the prospectively collected aggregated data. Surgeries included: laparoscopic cholecystectomy, open inguinal hernia repair, laparoscopic inguinal hernia repair, partial mastectomy without sentinel lymph node biopsy, and partial mastectomy with sentinel lymph node biopsy.
Eight hundred forty-seven opioid-naïve patients who underwent 1 of the 5 studied procedures reported counts of unused opioid pills after discharge. Forty-one percent did not take any opioid medications, and across all surgeries, the median consumption was 3 5 mg oxycodone pills or less. Generally, consensus reports recommended opioid quantities that were greater than the 75th percentile of consumption, and for 2 procedures, recommendations exceeded the 90th percentile of consumption.
Although consensus recommendations were an important first step to address opioid prescribing, our data suggests that following these recommendations would result in 47%-56% of pills prescribed remaining unused. Future multi-institutional efforts should be directed toward refining and personalizing prescribing recommendations.
我们将比较 5 种手术的共识推荐意见与前瞻性收集的患者消费数据。为了解决局部差异，我们合并了全国多家医院的数据。
解决阿片类药物泛滥问题的一种方法是为常见手术制定处方共识报告。然而，这些指南与来自多个医院系统的患者报告数据相比如何尚不清楚。
前瞻性观察研究了 3/2017 至 12/2018 期间的手术患者。数据是通过来自美国 5 个州的 5 家医院（代表 3 个医院系统）的出院后调查和病历回顾收集的。比较了最近 2 份共识报告中确定的 5 种常见手术的推荐处方与前瞻性收集的汇总数据。手术包括：腹腔镜胆囊切除术、开放性腹股沟疝修补术、腹腔镜腹股沟疝修补术、无前哨淋巴结活检的部分乳房切除术和有前哨淋巴结活检的部分乳房切除术。
847 名接受 5 种研究手术之一的阿片类药物初治患者报告了出院后未使用的阿片类药物丸数。41%的患者未服用任何阿片类药物，在所有手术中，中位数消耗量为 3 5mg 羟考酮丸或更少。总体而言，共识报告推荐的阿片类药物用量大于消耗量的 75 百分位，对于 2 种手术，推荐用量超过消耗量的 90 百分位。
尽管共识推荐意见是解决阿片类药物处方问题的重要第一步，但我们的数据表明，遵循这些建议将导致 47%-56%的处方药丸未使用。未来的多机构努力应致力于完善和个性化处方建议。
