Shanahan Christopher W, Reding Olivia, Holmdahl Inga, Keosaian Julia, Xuan Ziming, McAneny David, Larochelle Marc, Liebschutz Jane
Section of General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
Section of General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts, USA.
BMJ Open. 2021 Aug 12;11(8):e047928. doi: 10.1136/bmjopen-2020-047928.
To prospectively characterise: (1) postoperative opioid analgesic prescribing practices; (2) experience of patients undergoing elective ambulatory surgeries and (3) impact of patient risk for medication misuse on postoperative pain management.
Longitudinal survey of patients 7 days before and 7-14 days after surgery.
Academic urban safety-net hospital.
181 participants recruited, 18 surgeons, follow-up data from 149 participants (82% retention); 54% women; mean age: 49 years.
None.
Total morphine equivalent dose (MED) prescribed and consumed, percentage of unused opioids.
Surgeons postoperatively prescribed a mean of 242 total MED per patient, equivalent to 32 oxycodone (5 mg) pills. Participants used a mean of 116 MEDs (48%), equivalent to 18 oxycodone (5 mg) pills (~145 mg of oxycodone remaining per patient). A 10-year increase in patient age was associated with 12 (95% CI (-2.05 to -0.35)) total MED fewer prescribed opioids. Each one-point increase in the preoperative Graded Chronic Pain Scale was associated with an 18 (6.84 to 29.60) total MED increase in opioid consumption, and 5% (-0.09% to -0.005%) fewer unused opioids. Prior opioid prescription was associated with a 55 (5.38 to -104.82) total MED increase in opioid consumption, and 19% (-0.35% to -0.02%) fewer unused opioids. High-risk drug use was associated with 9% (-0.19% to 0.002%) fewer unused opioids. Pain severity in previous 3 months, high-risk alcohol, use and prior opioid prescription were not associated with postoperative prescribing practices.
Participants with a preoperative history of chronic pain, prior opioid prescription, and high-risk drug use were more likely to consume higher amounts of opioid medications postoperatively. Additionally, surgeons did not incorporate key patient-level factors (eg, substance use, preoperative pain) into opioid prescribing practices. Opportunities to improve postoperative opioid prescribing include system changes among surgical specialties, and patient education and monitoring.
前瞻性地描述：（1）术后阿片类镇痛药的处方实践；（2）接受择期门诊手术患者的经历；（3）患者药物滥用风险对术后疼痛管理的影响。
对患者术前7天及术后7 - 14天进行纵向调查。
城市学术安全网医院。
招募了181名参与者，18名外科医生，149名参与者的随访数据（保留率82%）；54%为女性；平均年龄：49岁。
无。
处方和消耗的吗啡当量总量（MED）、未使用阿片类药物的百分比。
外科医生术后每位患者平均处方242 MED，相当于32片羟考酮（5毫克）。参与者平均使用116 MED（48%），相当于18片羟考酮（5毫克）（每位患者约剩余145毫克羟考酮）。患者年龄每增加10岁，处方阿片类药物总量减少12（95%置信区间（-2.05至-0.35））。术前慢性疼痛分级量表每增加1分，阿片类药物消耗量增加18（6.84至29.60）MED，未使用阿片类药物减少5%（-0.09%至-0.005%）。既往阿片类药物处方与阿片类药物消耗量增加55（5.38至-104.82）MED及未使用阿片类药物减少19%（-0.35%至-0.02%）相关。高风险药物使用与未使用阿片类药物减少9%（-0.19%至0.002%）相关。过去3个月的疼痛严重程度、高风险饮酒、药物使用及既往阿片类药物处方与术后处方实践无关。
有慢性疼痛病史、既往阿片类药物处方及高风险药物使用史的参与者术后更可能消耗大量阿片类药物。此外，外科医生在阿片类药物处方实践中未纳入关键的患者层面因素（如药物使用、术前疼痛）。改善术后阿片类药物处方的机会包括外科专科的系统变革以及患者教育和监测。
