Burgess Jessica R, Heneghan Kathleen C, Barot Tarra G, Stulberg Jonah J
Department of Surgery, Eastern Virginia Medical School, 6th Floor Hofheimer Hall, 825 Fairfax Avenue, Norfolk, VA, 23507, USA.
Division of Education, American College of Surgeons, Chicago, IL, USA.
Patient Saf Surg. 2024 Mar 4;18(1):9. doi: 10.1186/s13037-024-00392-1.
Patients with opioid use disorder (OUD) are increasing, challenging surgeons to adjust post-operative pain management guidelines. A literature review identified limited information on how to best care for these patients. The purpose of this study was to determine surgical perioperative management of OUD, challenges, and support needed for optimal care.
This study utilized an anonymous voluntary survey that was distributed to members of the American College of Surgeons through the association's electronic weekly newsletter. The survey was advertised weekly for three consecutive weeks. The survey included questions regarding surgeons' management of perioperative pain in patients with opioid use disorder and perceived barriers in treatment.
A total of 260 surgeons responded representing all specialties except ophthalmology. General surgery (66.5%) and plastic and reconstructive surgery (7.5%) represented the majority of responders. Ninety-five percent of surgeons reported treating a patient who used opioids in the past month and 86% encountered a patient with OUD. Nearly half (46%) reported being uncomfortable managing postoperative pain in patients with OUD. Most (67%) were not aware of any guidelines or standards pertaining to perioperative management of patients with OUD. While consultation was sought by 86% of surgeons, analyses identified lack of timely response and a lack of care coordination among specialists. Lack of knowledge and fear of harm (contributing further to addiction) were the most common themes.
Nearly half of surgeons report discomfort caring for patients with OUD with the vast majority involving a consulting service to assist with their care. Most surgeons believe that it would be helpful to have guidelines regarding the care of these patients. This provides an opportunity for increased education and training on the perioperative management of patients with OUD and further collaboration with addiction medicine, psychiatry and pain management colleagues.
患有阿片类药物使用障碍（OUD）的患者数量不断增加，这给外科医生调整术后疼痛管理指南带来了挑战。一项文献综述发现，关于如何最好地照顾这些患者的信息有限。本研究的目的是确定OUD患者的手术围手术期管理、挑战以及最佳护理所需的支持。
本研究采用了一项匿名自愿调查，通过美国外科医师学会的电子周刊分发给该学会的成员。该调查连续三周每周进行宣传。调查包括有关外科医生对阿片类药物使用障碍患者围手术期疼痛的管理以及治疗中感知到的障碍的问题。
共有260名外科医生做出回应，代表了除眼科以外的所有专科。普通外科（66.5%）和整形与重建外科（7.5%）的回应者占大多数。95%的外科医生报告在过去一个月内治疗过使用阿片类药物的患者，86%的医生遇到过患有OUD的患者。近一半（46%）的医生报告在管理OUD患者的术后疼痛时感到不自在。大多数（67%）医生不知道任何与OUD患者围手术期管理相关的指南或标准。虽然86%的外科医生寻求了会诊，但分析发现缺乏及时回应以及专科医生之间缺乏护理协调。知识不足和对伤害的恐惧（进一步导致成瘾）是最常见的主题。
近一半的外科医生报告在照顾OUD患者时感到不自在，绝大多数情况下需要咨询服务来协助护理。大多数外科医生认为制定有关这些患者护理的指南会有所帮助。这为增加关于OUD患者围手术期管理的教育和培训以及与成瘾医学、精神病学和疼痛管理同事的进一步合作提供了机会。
