College of Medicine, 12215University of Arkansas for Medical Sciences, Little Rock, AR, USA.
Department of Surgery, College of Medicine, 12215University of Arkansas for Medical Sciences, Little Rock, AR, USA.
Am Surg. 2022 Jul;88(7):1479-1483. doi: 10.1177/00031348221082280. Epub 2022 Mar 25.
More than 5 million Americans misuse opioids. Six percent of patients who receive opioids for acute pain progress to chronic use; this increases with higher doses and longer prescriptions. Prescribing variation exists within trauma centers and after emergency surgery but has not been demonstrated among intensivists.
Milligram morphine equivalents (MME) per patient-ICU-day provided by eleven surgical intensivists were analyzed. The patients were separated into 2 groups based on their percentage of time intubated in the surgical ICU. Both study groups were compared using demographics and comorbidity scores. The attendings were divided into high- and low-prescribing groups based on their MME/pt-ICU-day for intubated patients, and bivariate statistical analyses were performed. A similar analysis compared surgery vs anesthesia intensivists.
The analysis included 257 patients in the "long-vent group" (LVG) and 668 patients in the "short-vent group" (SVG). The average MME/pt-ICU-day for the LVG was 222. Despite no significant differences in age, sex, or Elixhauser Comorbidity Index, there was a 45% difference between the high- and low-prescribing physicians in the LVG (253.7 vs 175.4 MME/pt-ICU-day; = .008). This difference was not observed for patients in the SVG (74.3 vs 93.1 MME/pt-ICU-day; = .141) nor based on intensivist specialty (LVG: 217.9 vs 209.5 MME/pt-ICU-day; = .8) (SVG: 79.0 vs 93.3 MME/pt-ICU-day; = .288).
超过 500 万美国人滥用阿片类药物。接受阿片类药物治疗急性疼痛的患者中有 6%进展为慢性使用；剂量越高、处方时间越长，这种情况就越常见。创伤中心和急诊手术后存在处方差异，但在重症监护医生中尚未得到证实。
分析了 11 名外科重症监护医生为每位患者-重症监护病房日提供的吗啡毫克当量（MME）。根据患者在外科重症监护病房插管的时间百分比，将患者分为两组。使用人口统计学和合并症评分比较两组研究对象。根据插管患者的 MME/pt-ICU-day 将主治医生分为高剂量和低剂量组，并进行双变量统计分析。还进行了一项类似的分析，比较了外科医生和麻醉医生。
该分析包括 257 例“长时间通气组”（LVG）和 668 例“短时间通气组”（SVG）患者。LVG 的平均 MME/pt-ICU-day 为 222。尽管高剂量和低剂量组在年龄、性别或 Elixhauser 合并症指数方面没有显著差异，但 LVG 中高剂量和低剂量组医生之间的差异为 45%（253.7 与 175.4 MME/pt-ICU-day； =.008）。SVG 患者中未观察到这种差异（74.3 与 93.1 MME/pt-ICU-day； =.141），也未根据重症监护医生的专业知识进行观察（LVG：217.9 与 209.5 MME/pt-ICU-day； =.8）（SVG：79.0 与 93.3 MME/pt-ICU-day； =.288）。
