NYU Langone Health and NYU Langone Laura and Isaac Perlmutter Cancer Center, New York New York.
Obstet Gynecol. 2020 Dec;136(6):1126-1134. doi: 10.1097/AOG.0000000000004158.
To implement a quality-improvement intervention aimed at reducing unnecessary opioid prescriptions for patients who are undergoing gynecologic surgery.
This was a retrospective cohort study that included data from the pre- and post-quality-improvement initiative cohorts. Patients at an urban, tertiary academic medical center who were undergoing scheduled minimally invasive surgery and open abdominal surgery by a gynecologic oncologist were included. Patients underwent preoperative counseling, standardization of perioperative analgesia, and a postoperative opioid prescribing algorithm. Descriptive statistics were calculated for demographic and perioperative characteristics, process measures, and outcome measures.
A total of 532 abdominal surgeries were analyzed. The total percentage of patients discharged with an opioid prescription decreased from 82.7% (n=229/276) to 23.1% (n=59/256) (P<.001) and was significantly reduced for all routes of surgery. The mean number of opioid tablets prescribed for all patients was significantly reduced from 7.2 tablets (SD=5.7) to 1.8 tablets (SD=4.3) (P<.001). Eighty-three percent of patients (n=97/117) who underwent minimally invasive hysterectomy and were discharged on postoperative day 0 or day 1 were not provided an opioid prescription. Fifty-one percent of patients who underwent laparotomy were discharged without an opioid prescription. The percentage of patients who required an opioid refill or new prescription in the preintervention and postintervention cohorts remained constant (6.5%, n=18/276 vs 5.9%, n=15/256, P=.75), as did postoperative calls for pain (8.3%, n=23/276 vs 10.9%, n=33/256).
Patients who are undergoing scheduled abdominal gynecologic surgery can be safely discharged without opioid prescriptions with appropriate education and perioperative analgesia prescribing practices. These protocols and prescribing practices profoundly limit opioid prescriptions, which is an important factor in combating the ongoing opioid crisis.
实施一项旨在减少妇科手术患者不必要的阿片类药物处方的质量改进干预措施。
这是一项回顾性队列研究，包括质量改进干预措施前和后队列的数据。纳入在城市三级学术医疗中心接受妇科肿瘤医生计划微创和开腹手术的患者。患者接受术前咨询、围手术期镇痛标准化和术后阿片类药物处方算法。计算人口统计学和围手术期特征、过程指标和结果指标的描述性统计数据。
共分析了 532 例腹部手术。接受阿片类药物处方出院的患者总数百分比从 82.7%（n=229/276）降至 23.1%（n=59/256）（P<.001），所有手术途径的降幅均显著。所有患者开具的阿片类药物片剂数量从 7.2 片（SD=5.7）显著减少至 1.8 片（SD=4.3）（P<.001）。接受微创子宫切除术并在术后第 0 天或第 1 天出院的 117 例患者中有 83%（n=97）未开具阿片类药物处方。51%接受剖腹手术的患者未开具阿片类药物处方出院。在干预前和干预后队列中，需要阿片类药物续药或新处方的患者比例保持不变（6.5%，n=18/276 与 5.9%，n=15/256，P=.75），术后因疼痛致电的患者比例也保持不变（8.3%，n=23/276 与 10.9%，n=33/256）。
接受计划腹部妇科手术的患者可以在接受适当的教育和围手术期镇痛处方实践后安全地不服用阿片类药物出院。这些方案和处方实践极大地限制了阿片类药物处方，这是对抗持续的阿片类药物危机的一个重要因素。
