East Midlands Surgical Academic Network, Queen's Medical Centre, Nottingham, UK.
Gastro-intestinal Surgery, Nottingham Digestive Diseases Centre, National Institute for Health Research, Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, UK.
Anaesthesia. 2021 Oct;76(10):1367-1376. doi: 10.1111/anae.15460. Epub 2021 Mar 25.
Opioid misuse is now considered a major public health epidemic in North America, with substantial social and financial consequences. As well as socio-economic and commercial drivers, modifiable risk-factors that have resulted in this crisis have been identified. The purpose of this study was to identify whether, within England, modifiable drivers for persistent postoperative opioid use were present. This was a retrospective cohort study of practice at 14 National Health Service hospitals across England. Data were collected retrospectively and validated for adult patients undergoing elective intermediate and major or complex major general surgical procedures between 1 and 31 March 2019. Of the 509 patients enrolled from 14 centres, 499 were included in the data analysis. In total, 31.5% (157/499) patients were in the intermediate surgery cohort and 68.5% (342/499) were in the major or complex major surgery cohort, with 21.0% (33/157) and 21.6% (74/342) discharged with opioid medicines to be taken at regular intervals, respectively. There were similar median oral morphine equivalent doses prescribed at discharge. Of patients prescribed regular opioid medicines, 76.6% (82/107) had a specified duration at discharge. However, 72.9% (78/107) had no written deprescribing advice on discharge. Similarly, of patients prescribed 'when required' opioids, 59.6% (93/156) had a specified duration of their prescription and 33.3% (52/156) were given written deprescribing advice. This study has identified a pattern of poor prescribing practices, a lack of guidance and formal training at individual institutions and highlights opportunities for improvement in opioid-prescribing practices within England.
阿片类药物滥用现在被认为是北美的一个主要公共卫生流行病，带来了巨大的社会和经济后果。除了社会经济和商业驱动因素外，还确定了导致这场危机的可改变的风险因素。本研究的目的是确定在英格兰，是否存在持续术后阿片类药物使用的可改变驱动因素。这是一项对英格兰 14 家国民保健服务医院的实践进行的回顾性队列研究。数据是在 2019 年 3 月 1 日至 31 日期间，对接受择期中等级别和大手术或复杂大手术的成年患者进行回顾性收集和验证的。从 14 个中心共纳入 509 名患者，其中 499 名纳入数据分析。在总共 499 名患者中，31.5%（157/499）的患者在中等级别手术队列中，68.5%（342/499）的患者在大手术或复杂大手术队列中，分别有 21.0%（33/157）和 21.6%（74/342）的患者出院时开具了定期服用的阿片类药物。出院时开具的口服吗啡等效剂量中位数相似。在开具常规阿片类药物的患者中，76.6%（82/107）在出院时指定了具体的使用时间。然而，72.9%（78/107）在出院时没有书面的去阿片化建议。同样，在开具按需阿片类药物的患者中，59.6%（93/156）的处方有具体的使用时间，33.3%（52/156）的患者收到了书面去阿片化建议。本研究发现了一种不良的处方实践模式，各医疗机构缺乏指导和正规培训，突出了改善英格兰阿片类药物处方实践的机会。
