Michigan Bariatric Surgical Collaborative, United States; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, United States.
Michigan Bariatric Surgical Collaborative, United States; Henry Ford Health System, Detroit, United States.
Am J Surg. 2023 Jan;225(1):184-190. doi: 10.1016/j.amjsurg.2022.07.023. Epub 2022 Jul 31.
Opioid prescribing following bariatric surgery has been a focus due to its association with new persistent opioid use (NPOU) and worse outcomes. Guidelines have led to a reduction in opioids prescribed, but there remains variation in prescribing practices.
We conducted interviews with 20 bariatric surgeons across Michigan. Transcripts were analyzed using descriptive content analysis.
At the patient level, surgeons described the role of surgical history and pain tolerance. At the provider level, surgeons discussed patient dissatisfaction, reputation, and workload. At the institution level, surgeons discussed colleagues, resources, and administration. At a collaborative level, surgeons described the role of evidence and performance measures. There was lack of consensus on whether NPOU is a problem facing patients undergoing bariatric surgery.
Despite efforts aimed at addressing opioid prescribing, variability exists in prescribing practices. Understanding determinants that impact stakeholder alignment is critical to increasing adherence to guideline-concordant care.
由于肥胖症手术后开具阿片类药物与新的持续性阿片类药物使用（NPOU）和更糟糕的结果有关，因此成为关注的焦点。指南的颁布减少了开具的阿片类药物数量，但开具的做法仍存在差异。
我们在密歇根州对 20 名肥胖症外科医生进行了访谈。使用描述性内容分析对转录本进行了分析。
在患者层面，外科医生描述了手术史和疼痛耐受能力的作用。在提供者层面，外科医生讨论了患者的不满、声誉和工作量。在机构层面，外科医生讨论了同事、资源和行政部门。在协作层面，外科医生描述了证据和绩效措施的作用。对于 NPOU 是否是肥胖症手术患者面临的问题，各方没有达成共识。
尽管为解决阿片类药物处方问题做出了努力，但处方做法仍存在差异。了解影响利益相关者一致性的决定因素对于增加对符合指南的护理的依从性至关重要。
