术后标准阿片类药物处方方案的实施可减少阿片类药物处方，而不会改变患者报告的疼痛结果。
Implementation of Postoperative Standard Opioid Prescribing Schedules Reduces Opioid Prescriptions Without Change in Patient-reported Pain Outcomes.
机构信息
Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC.
University of North Carolina School of Pharmacy, Chapel Hill, NC.
出版信息
Urology. 2021 Feb;148:126-133. doi: 10.1016/j.urology.2020.11.009. Epub 2020 Nov 18.
OBJECTIVE
To implement Standard Opioid Prescribing Schedules (SOPS) based on opioid use following urologic surgeries and to evaluate how evidence-based prescribing schedules affect opioid use and patient reported outcomes.
METHODS
Patients who underwent urologic surgeries within 6 procedure subtypes at UNC Health during the 2 study time periods ("pre-SOPS": 7/2017-1/2018, "post-SOPS": 7/2018-1/2019) were invited to complete a survey analyzing postoperative opioid usage, storage and disposal, and patient reported outcomes (including pain interference using a validated questionnaire). A pharmacy database provided medication prescribing data and patient demographics. During the pre-SOPS time period, baseline outcomes were measured. Following the pre-SOPS period, usage amounts were analyzed and Standard Opioid Prescribing Schedules were developed to guide prescriptions during the post-SOPS period. Descriptive summary statistics and appropriate t test or r were calculated.
RESULTS
A total of 438 patients within 6 procedure types completed the survey (pre-SOPS: 282 patients, post-SOPS: 156 patients). Pre-SOPS, patients were prescribed significantly more 5-mg oxycodone tablets than used (20.9 vs 7.8, P <.001). Post-SOPS, compared to pre-SOPS amounts, patients were prescribed significantly fewer tablets (12.7 vs 20.9, P <.001) and used fewer tablets (5.3 vs 7.8, P = .003). No difference was observed in pain interference (average t-score (standard deviation): 54.33 (10.9) pre-SOPS vs 55.89 (9.1) post-SOPS, P = .125) or patient satisfaction (95% pre-SOPS vs 94% post-SOPS).
CONCLUSION
Adherence to data-driven postoperative opioid prescribing schedules reduce opioid prescriptions and use without compromising pain interference or patient satisfaction. These results have important implications for urologists' ability to decrease opioid prescriptions and fight the opioid epidemic.
目的
根据泌尿外科手术后的阿片类药物使用情况实施标准阿片类药物处方计划（SOPS），并评估基于证据的处方计划如何影响阿片类药物的使用和患者报告的结果。
方法
在 UNC Health 进行的 6 种手术类型中接受泌尿外科手术的患者（研究期间为“SOPS 前”：2017 年 7 月至 2018 年 1 月，“SOPS 后”：2018 年 7 月至 2019 年 1 月）被邀请完成一项分析术后阿片类药物使用、储存和处理以及患者报告结果（包括使用经过验证的问卷分析疼痛干扰）的调查。药房数据库提供了药物处方数据和患者人口统计学信息。在 SOPS 前期间，测量了基线结果。在 SOPS 前期间之后，分析了使用量，并制定了标准阿片类药物处方计划，以指导 SOPS 后期间的处方。计算了描述性汇总统计数据和适当的 t 检验或 r。
结果
共有 6 种手术类型中的 438 名患者完成了调查（SOPS 前：282 名患者，SOPS 后：156 名患者）。在 SOPS 前，患者开具的 5 毫克羟考酮片明显多于使用量（20.9 比 7.8，P<.001）。在 SOPS 后，与 SOPS 前相比，患者开具的片剂明显减少（12.7 比 20.9，P<.001），使用的片剂也减少（5.3 比 7.8，P=.003）。疼痛干扰方面没有差异（平均 t 分数（标准差）：SOPS 前 54.33（10.9），SOPS 后 55.89（9.1），P=.125）或患者满意度（95% SOPS 前比 94% SOPS 后）。
结论
遵守基于数据的术后阿片类药物处方计划可减少阿片类药物处方和使用，而不会影响疼痛干扰或患者满意度。这些结果对泌尿科医生减少阿片类药物处方和对抗阿片类药物流行具有重要意义。
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