Department of Surgery, Kaiser Permanente Fremont Medical Center, Fremont, CA, USA.
Department of Surgery, Kaiser Permanente South Sacramento Medical Center, Sacramento, CA, USA.
Ann Surg Oncol. 2020 Nov;27(12):4835-4843. doi: 10.1245/s10434-020-08897-6. Epub 2020 Aug 6.
Postoperative prescriptions have contributed to the opioid epidemic. In response, a large, integrated health care delivery system implemented initiatives to reduce outpatient opioid prescriptions. We evaluated the impact of these interventions on opioid-prescribing practices after breast surgery.
We examined postoperative prescribing practices before and after the 2016-2018 intervention period. Primary endpoints were the use of non-opioid regimens (NORs) and morphine milligram equivalents (MMEs) prescribed for postoperative pain management, while secondary endpoints were emergency department (ED) visits and readmissions within 7 days of surgery.
In a survey of breast surgeons, 23% reported using NORs in 2017 versus 79% in 2019 (p < 0.001). Comparing 1917 breast operations from 2016 with 2166 operations from 2019, NORs increased from 9% in 2016 to 39% in 2019 (p < 0.001). Average discharge MMEs per operation decreased from 190 in 2016 to 106 in 2019 (p < 0.001). NOR failure (defined as an additional opioid prescription within 2 weeks of surgery) was < 1%. Significantly fewer postoperative ED visits occurred in the NOR group (1.9% NOR vs. 3.4% opioid regimen [OR]; p < 0.001). The 7-day readmission rates for NOR and OR patients were similar (0.49% NOR vs. 0.32% OR; p = 0.45).
Between 2016 and 2019, breast surgeons in a large, integrated health care delivery system adopted NORs for nearly 40% of breast operations, and prescribed significantly fewer MMEs, with no increases in ED visits or readmissions for NOR patients. This suggests that initiatives to decrease opioid prescribing were successful and that a NOR for pain management after breast surgery is feasible.
术后处方是阿片类药物流行的原因之一。作为回应，一个大型的综合性医疗保健服务系统实施了一系列措施，以减少门诊阿片类药物的处方。我们评估了这些干预措施对乳房手术后阿片类药物处方的影响。
我们在干预期（2016 年至 2018 年）前后检查了术后的处方情况。主要终点是术后疼痛管理中使用非阿片类药物方案（NOR）和吗啡毫克当量（MME）的情况，次要终点是术后 7 天内急诊就诊和再入院的情况。
在对乳房外科医生的调查中，2017 年有 23%的医生报告使用 NOR，而 2019 年则有 79%的医生报告使用（p<0.001）。比较 2016 年的 1917 例乳房手术和 2019 年的 2166 例手术，NOR 的使用从 2016 年的 9%增加到 2019 年的 39%（p<0.001）。每例手术出院时 MME 的平均值从 2016 年的 190 减少到 2019 年的 106（p<0.001）。NOR 失败（定义为术后 2 周内开具额外的阿片类药物处方）<1%。NOR 组的术后急诊就诊率显著较低（1.9% NOR 与 3.4%阿片类药物方案[OR]；p<0.001）。NOR 和 OR 患者的 7 天再入院率相似（0.49% NOR 与 0.32% OR；p=0.45）。
在 2016 年至 2019 年期间，一个大型的综合性医疗保健服务系统中的乳房外科医生采用 NOR 治疗了近 40%的乳房手术，处方的 MME 明显减少，而 NOR 患者的急诊就诊率和再入院率没有增加。这表明减少阿片类药物处方的措施是成功的，乳房手术后使用 NOR 治疗疼痛是可行的。
