一项前瞻性可行性研究，评估5倍乘数法在癌症手术患者出院处方标准化中的应用。
A prospective feasibility study evaluating the 5x-multiplier to standardize discharge prescriptions in cancer surgery patients.
作者信息
DiPeri Timothy P, Newhook Timothy E, Day Ryan W, Chiang Yi-Ju, Dewhurst Whitney L, Arvide Elsa M, Bruno Morgan L, Scally Christopher P, Roland Christina L, Katz Matthew H G, Vauthey Jean-Nicolas, Chang George J, Badgwell Brian D, Perrier Nancy D, Grubbs Elizabeth G, Lee Jeffrey E, Tzeng Ching-Wei D
机构信息
Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
Department of Surgery, Division of Transplant Surgery, University of California San Francisco, San Francisco, CA.
出版信息
Surg Open Sci. 2022 Apr 25;9:51-57. doi: 10.1016/j.sopen.2022.04.004. eCollection 2022 Jul.
BACKGROUND
We designed a prospective feasibility study to assess the 5x-multiplier (5x) calculation (eg, 3 pills in last 24 hours × 5 = 15) to standardize discharge opioid prescriptions compared to usual care.
METHODS
Faculty-based surgical teams volunteered for either 5x or usual care arms. Patients undergoing inpatient (≥ 48 hours) surgery and discharged by surgical teams were included. The primary end point was discharge oral morphine equivalents. Secondary end points were opioid-free discharges and 30-day refill rates.
RESULTS
Median last 24-hour oral morphine equivalents was similar between arms (7.5 mg 5x vs 10 mg usual care, P = .830). Median discharge oral morphine equivalents were less in the 5x arm (50 mg 5x vs 75 mg usual care, P < .001). Opioid-free discharges included 33.5% 5x vs 18.0% usual care arm patients (P < .001). Thirty-day refill rates were similar (15.3% 5x vs 16.5% usual care, P = .742).
CONCLUSION
The 5x-multiplier was associated with reduced opioid prescriptions without increased refills and can be feasibly implemented across a diverse surgical practice.
背景
我们设计了一项前瞻性可行性研究，以评估5倍乘数（5x）计算方法（例如，过去24小时内服用3片药×5 = 15）与常规护理相比，用于标准化出院时阿片类药物处方的效果。
方法
以教员为基础的外科团队自愿参与5x组或常规护理组。纳入由外科团队进行住院手术（≥48小时）并出院的患者。主要终点是出院时口服吗啡当量。次要终点是无阿片类药物出院率和30天再填充率。
结果
两组之间过去24小时口服吗啡当量中位数相似（5x组为7.5mg，常规护理组为10mg，P = 0.830）。5x组出院时口服吗啡当量中位数较低（5x组为50mg，常规护理组为75mg，P <0.001）。无阿片类药物出院的患者中，5x组占33.5%，常规护理组占18.0%（P <0.001）。30天再填充率相似（5x组为15.3%，常规护理组为16.5%，P = 0.742）。
结论
5倍乘数与减少阿片类药物处方相关，且再填充率未增加，并且可以在不同的外科实践中切实可行地实施。
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