Percy Edward D, Hirji Sameer, Cote Claudia, Laurin Charles, Atkinson Logan, Kiehm Spencer, Malarczyk Alexandra, Harloff Morgan, Bozso Sabin J, Buyting Ryan, Fatehi Hassanabad Ali, Guo Ming Hao, Jaffer Iqbal, Lodewyks Carly, Tam Derrick Y, Tremblay Philippe, Légaré Jean-François, Cook Richard, Kaneko Tsuyoshi, Pelletier Marc P
Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Division of Cardiovascular Surgery, University of British Columbia, Vancouver, Canada.
J Card Surg. 2020 Oct;35(10):2657-2662. doi: 10.1111/jocs.14885. Epub 2020 Jul 27.
The opioid epidemic has become a major public health crisis in recent years. Discharge opioid prescription following cardiac surgery has been associated with opioid use disorder; however, ideal practices remain unclear. Our aim was to examine current practices in discharge opioid prescription among cardiac surgeons and trainees.
A survey instrument with open- and closed-ended questions, developed through a 3-round Delphi method, was circulated to cardiac surgeons and trainees via the Canadian Society of Cardiac Surgeons. Survey questions focused on routine prescription practices including type, dosage and duration. Respondents were also asked about their perceptions of current education and guidelines surrounding opioid medication.
Eighty-one percent of respondents reported prescribing opioids at discharge following routine sternotomy-based procedures, however, there remained significant variability in the type and dose of medication prescribed. The median (interquartile range) number of pills prescribed was 30 (20-30) with a median total dose of 135 (113-200) Morphine Milligram Equivalents. Informal teaching was the most commonly reported primary influence on prescribing habits and a lack of formal education regarding opioid prescription was associated with a higher number of pills prescribed. A majority of respondents (91%) felt that there would be value in establishing practice guidelines for opioid prescription following cardiac surgery.
Significant variability exists with respect to routine opioid prescription at discharge following cardiac surgery. Education has come predominantly from informal sources and there is a desire for guidelines. Standardization in this area may have a role in combatting the opioid epidemic.
近年来，阿片类药物泛滥已成为重大的公共卫生危机。心脏手术后出院时开具阿片类药物处方与阿片类药物使用障碍有关；然而，理想的做法仍不明确。我们的目的是调查心脏外科医生和实习医生在出院时开具阿片类药物处方的现行做法。
通过三轮德尔菲法开发的一份包含开放式和封闭式问题的调查问卷，通过加拿大心脏外科医生协会分发给心脏外科医生和实习医生。调查问题集中在常规处方做法，包括类型、剂量和持续时间。受访者还被问及他们对当前围绕阿片类药物的教育和指南的看法。
81%的受访者报告在基于胸骨切开术的常规手术后出院时开具阿片类药物处方，然而，所开具药物的类型和剂量仍存在显著差异。开具药丸的中位数（四分位间距）为30（20 - 30），吗啡毫克当量的总剂量中位数为135（113 - 200）。非正式教学是最常被报告的对处方习惯的主要影响因素，而缺乏关于阿片类药物处方的正规教育与开具更多药丸数量有关。大多数受访者（91%）认为制定心脏手术后阿片类药物处方的实践指南会有价值。
心脏手术后出院时常规阿片类药物处方存在显著差异。教育主要来自非正式来源，且人们渴望有指南。这一领域的标准化可能在应对阿片类药物泛滥方面发挥作用。
