Department of Surgery, 12239Emory University School of Medicine, Atlanta, GA, USA.
Department of Surgery, 5223Navicent Health Medical Center, Macon, GA, USA.
Am Surg. 2022 Jul;88(7):1510-1516. doi: 10.1177/00031348221082286. Epub 2022 Mar 25.
Excessive postoperative opioid prescribing contributes to opioid misuse throughout the US. The Georgia Quality Improvement Program (GQIP) is a collaboration of ACS-NSQIP participating hospitals. GQIP aimed to develop a multi-institutional opioid data collection platform as well as understand our current opioid-sparing strategy (OSS) usage and postoperative opioid prescribing patterns.
This study was initiated 7/2019, when 4 custom NSQIP variables were developed to capture OSS usage and postoperative opioid oral morphine equivalents (OMEs). After pilot collection, our discharge opioid variable required optimization for adequate data capture and was expanded from a free text option to 4 drop-down selection variables. Data collection then continued from 2/2020-5/2021. Logistic regression was used to determine associations with OSS usage. Average OMEs were calculated for common general surgery procedures and compared to national guidelines.
After variable optimization, the percentage where a total discharge prescription OME could be calculated increased from 26% to 70% ( < .001). The study included 820 patients over 10 operations. There was a significant variation in OSS usage between GQIP centers. Laparoscopic cases had higher odds of OSS use (1.92 (1.38-2.66)) while OSS use had lower odds in black patients on univariate analysis (.69 (.51-.94)). On average 7 out of the 10 cases had higher OMEs prescribed compared to national guidelines recommendations.
Developing a multi-institutional opioid data collection platform through ACS-NSQIP is feasible. Preselected drop-down boxes outperform free text variables. GQIP future quality improvement targets include variation in OSS use and opioid overprescribing.
美国过度开具术后阿片类药物处方导致阿片类药物滥用。乔治亚州质量改进计划（GQIP）是 ACS-NSQIP 参与医院的合作项目。GQIP 的目标是开发一个多机构阿片类药物数据收集平台，并了解我们目前的阿片类药物节约策略（OSS）的使用情况和术后阿片类药物处方模式。
本研究始于 2019 年 7 月，当时开发了 4 个定制的 NSQIP 变量来捕捉 OSS 的使用情况和术后阿片类药物口服吗啡当量（OME）。在试点收集后，我们的出院阿片类药物变量需要进行优化，以充分收集数据，并从自由文本选项扩展到 4 个下拉选择变量。然后从 2020 年 2 月到 2021 年 5 月继续收集数据。使用逻辑回归来确定与 OSS 使用的关联。为常见的普通外科手术计算平均 OME，并与国家指南进行比较。
在变量优化后，能够计算总出院处方 OME 的百分比从 26%增加到 70%（<0.001）。该研究包括 10 种手术中的 820 名患者。GQIP 中心之间的 OSS 使用情况存在显著差异。腹腔镜病例使用 OSS 的可能性更高（1.92（1.38-2.66）），而在单变量分析中，黑人患者使用 OSS 的可能性较低（0.69（0.51-0.94））。平均而言，10 例中有 7 例处方的 OME 高于国家指南的建议。
通过 ACS-NSQIP 开发多机构阿片类药物数据收集平台是可行的。预选下拉框优于自由文本变量。GQIP 未来的质量改进目标包括 OSS 使用和阿片类药物过度处方的差异。
