Department of Surgery, Section of Colon and Rectal Surgery, Washington University School of Medicine, St. Louis, Missouri.
Dis Colon Rectum. 2023 Jun 1;66(6):840-847. doi: 10.1097/DCR.0000000000002483. Epub 2022 Dec 8.
Up to 10% of patients develop new, persistent opioid use after surgery. We aimed to assess our prescribing practices and patient utilization of opioids after colorectal surgery.
This study aimed to implement an opioid-prescribing protocol that will minimize the number of postoperative opioids to decrease community circulation and persistent use by patients.
This was a single-institution, prospective study based on questionnaires of postoperative patients in 2019 and 2020 to determine opioid prescribing and usage patterns. Based on these preliminary results, a protocol was implemented in which patients were discharged with 5 or 15 oxycodone 5 mg equivalents based on opioid usage in the 24 hours before discharge. Patients were surveyed after protocol implementation.
Our institution is a large referral center for surgical treatment of colorectal disease.
Adults who underwent inpatient abdominal colorectal procedures.
End points included the number of opioids prescribed, number of prescribed opioids taken, and refill rate. Nonparametric testing was used.
Of 77 eligible patients, 61 were opioid naive. Preprotocol, opioid-naive patients (n = 29) were prescribed a median of 30 (interquartile range [IQR], 30-45) tablets but took only 10 (IQR, 0-10; p < 0.0001). Eighty-three percent took 20 or fewer tablets. After protocol implementation, opioid-naive patients (n = 32) were prescribed fewer tablets (median 15; IQR, 7-15; p < 0.0001) but took a similar number of tablets as the preprotocol group (median 10; IQR, 0-10; p = 0.21). The refill rate remained similar (13.8% vs 18.8%; p = 0.60). Protocol adherence was 90.6%.
This study is limited by sample size, cohort heterogeneity, and generalizability.
Patients took significantly fewer opioids than were prescribed. Our protocol limited overprescribing and resulted in fewer opioids in the community without opportunity costs such as increased refills. Long-term studies are needed to assess the effects of persistent opioid use after surgery. See Video Abstract at http://links.lww.com/DCR/C93 .
多达 10%的患者在手术后会出现新的、持续的阿片类药物使用。我们旨在评估我们在结直肠手术后开具阿片类药物的处方实践和患者的使用情况。
本研究旨在实施一种阿片类药物处方方案，将术后阿片类药物的使用量降至最低，以减少社区流通和患者的持续使用。
这是一项基于 2019 年和 2020 年术后患者问卷调查的单机构、前瞻性研究，以确定阿片类药物的开具和使用模式。基于这些初步结果，实施了一项方案，根据出院前 24 小时内的阿片类药物使用情况，出院时给患者开具 5 或 15 个羟考酮 5mg 等效物。在方案实施后对患者进行了调查。
我们的机构是一家治疗结直肠疾病的大型转诊中心。
接受住院腹部结直肠手术的成年人。
包括开出的阿片类药物数量、开出的阿片类药物数量和补充率。采用非参数检验。
在 77 名符合条件的患者中，61 名患者为阿片类药物初治者。在方案实施前，阿片类药物初治患者（n=29）开具的中位数为 30 片（四分位距[IQR]，30-45），但仅服用 10 片（IQR，0-10；p<0.0001）。83%的患者服用 20 片以下。方案实施后，阿片类药物初治患者（n=32）开具的片剂数量较少（中位数 15；IQR，7-15；p<0.0001），但与方案实施前组服用的片剂数量相似（中位数 10；IQR，0-10；p=0.21）。补充率保持相似（13.8%比 18.8%；p=0.60）。方案的依从性为 90.6%。
本研究受到样本量、队列异质性和普遍性的限制。
患者服用的阿片类药物明显少于开具的处方量。我们的方案限制了过度开具处方，并在不增加补充量等机会成本的情况下减少了社区中的阿片类药物。需要进行长期研究来评估手术后持续使用阿片类药物的影响。在 http://links.lww.com/DCR/C93 查看视频摘要。
