Petrick Anthony T, Shah Tejen A, Gadaleta Dominick, Gould Jon, Morton John, Smith April, Evans-Labok Kimberly, Knapp Leandra, Ko Clifford Y, Brethauer Stacy A
Department of General Surgery, Geisinger Medical Center, Danville, Pennsylvania.
Division of Research and Optimal Patient Care, The American College of Surgeons, Chicago, Illinois; Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
Surg Obes Relat Dis. 2025 Apr;21(4):402-410. doi: 10.1016/j.soard.2024.11.011. Epub 2024 Dec 9.
Prescription opioids are responsible for a significant proportion of opioid-related deaths in the United States. Approximately 6% of opioid-naïve patients who receive opioid prescriptions after surgery become chronic opioid users. However, chronic opioid use after bariatric surgery may be twice as common.
This study aimed to report the feasibility and efficacy of implementing a national opioid-reducing protocol and to determine the impact of this protocol on opioid use after bariatric surgery.
Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP)-accredited hospitals.
Bariatric surgery targeting opioid prescription (BSTOP) was a national project sponsored by the MBSAQIP. It was executed in 3 phases: baseline, pilot, and implementation. A total of 271 MBSAQIP-accredited centers implemented the BSTOP protocol and reported data for all 3 phases. Protocol adherence, inpatient opioid use, opioids discharge prescribing, and outpatient opioid use were analyzed. Hospital-level opioid prescription habits were also assessed.
Compliance with 6 of 9 process measures improved significantly (P < .001). Median morphine milligram equivalents (MMEs) prescribed during inpatient stay decreased from 35 MMEs during data collection to 23 MMEs during the implementation phase (Dwass-Steel-Critchlow-Fligner, P < .001). Opioids prescribed at discharge decreased by 9.5% (P < .001). Low inpatient MME prescriptions were achieved by 14.2% of hospitals, while 15.7% of hospitals became low-discharge opioid prescribers.
Implementation of a national opioid-reducing protocol in bariatric surgery is feasible and effective in reducing opioid prescribing and use. However, the adoption of postdischarge prescription guidelines remains low. Opportunities to reduce the impact of prescription opioids on overdose deaths persist.
在美国，处方阿片类药物导致了相当一部分与阿片类药物相关的死亡。术后接受阿片类药物处方的未使用过阿片类药物的患者中，约6%会成为慢性阿片类药物使用者。然而，减肥手术后慢性阿片类药物的使用可能是其两倍。
本研究旨在报告实施全国性阿片类药物减量方案的可行性和有效性，并确定该方案对减肥手术后阿片类药物使用的影响。
代谢与减肥手术认证及质量改进计划（MBSAQIP）认证的医院。
减肥手术靶向阿片类药物处方（BSTOP）是一项由MBSAQIP赞助的全国性项目。它分三个阶段执行：基线、试点和实施。共有271个MBSAQIP认证中心实施了BSTOP方案，并报告了所有三个阶段的数据。分析了方案依从性、住院患者阿片类药物使用情况、出院时阿片类药物处方情况以及门诊阿片类药物使用情况。还评估了医院层面的阿片类药物处方习惯。
9项流程指标中的6项依从性显著提高（P <.001）。住院期间开具的吗啡毫克当量（MME）中位数从数据收集期间的35 MME降至实施阶段的23 MME（Dwass-Steel-Critchlow-Fligner检验，P <.001）。出院时开具的阿片类药物减少了9.5%（P <.001）。14.2%的医院实现了低住院MME处方，而15.7%的医院成为了低出院阿片类药物处方者。
在减肥手术中实施全国性阿片类药物减量方案在减少阿片类药物处方和使用方面是可行且有效的。然而，出院后处方指南的采用率仍然较低。减少处方阿片类药物对过量死亡影响的机会依然存在。
