Kim Bradford J, Newhook Timothy E, Blumenthaler Alisa, Chiang Yi-Ju, Aloia Thomas A, Roland Christina L, Katz Matthew H G, Vauthey Jean-Nicolas, Lee Jeffrey E, Tzeng Ching-Wei D
Department of Surgical Oncology, MD Anderson Cancer Center, The University of Texas, Houston, Texas, USA.
J Surg Oncol. 2021 Jul;124(1):143-151. doi: 10.1002/jso.26476. Epub 2021 Mar 22.
An opioid reduction education program to decrease discharge opioid prescriptions was initiated in our Department of Surgical Oncology. The study's aim was to measure the results and sustainability of these interventions 1 year later.
This prospective quality improvement project identified patients undergoing resection in five index tumor sites (peritoneal surface, sarcoma, stomach, pancreas, liver) at a high-volume cancer center. Patients were grouped into pre-education (PRE: July 2017-July 2018) and posteducation (POST: September 2018-July 2019) periods, before and after departmental education talks and videos in August 2018. Opioids were converted to oral morphine equivalents (OME) to compare the groups.
Of 1168 evaluable patients (PRE 646, 55%; POST 522, 45%), the median last-24-h inpatient OME was 15 mg in PRE patients and 10 mg in POST patients (p < .001). Median discharge OME decreased from 200 mg in PRE to 100 mg in POST patients (p < .001). The frequency of patients with zero discharge opioids increased from 11% to 19% (p < .001). This discharge OME reduction amounted to 52,200 mg OME saved, or the equivalent of 6960 5-mg oxycodone pills not disseminated.
A perioperative opioid reduction education program targeted to providers halved discharge OME, with sustained reductions 1 year later.
我们外科肿瘤学系启动了一项减少阿片类药物使用的教育计划，以减少出院时的阿片类药物处方。该研究的目的是在1年后评估这些干预措施的效果和可持续性。
这项前瞻性质量改进项目确定了一家大型癌症中心五个主要肿瘤部位（腹膜表面、肉瘤、胃、胰腺、肝脏）接受手术切除的患者。患者被分为教育前（PRE：2017年7月至2018年7月）和教育后（POST：2018年9月至2019年7月）两个阶段，分别在2018年8月科室进行教育讲座和播放视频之前和之后。将阿片类药物换算为口服吗啡当量（OME）以比较两组。
在1168例可评估患者中（PRE组646例，占55%；POST组522例，占45%），PRE组患者最后24小时住院期间OME的中位数为15毫克，POST组为10毫克（p<0.001）。出院时OME的中位数从PRE组的200毫克降至POST组的100毫克（p<0.001）。出院时未开具阿片类药物的患者比例从11%增至19%（p<0.001）。出院时OME的减少量达52200毫克，相当于6960片5毫克羟考酮未被发放。
针对医护人员的围手术期阿片类药物减少教育计划使出院时的OME减半，并在1年后持续减少。
