Barkho Jouseph O, Leveille Cameron, Pozdnyakov Alex, Faragalla Kyrillos M, Sengupta Neil K, Wong Chloe R, Shanthanna Harsha, Farrokhyar Forough, McRae Matthew C
Division of Plastic and Reconstructive Surgery, Department of Surgery, McMaster University, Hamilton, Canada.
Michael G. DeGoote School of Medicine, McMaster University, Hamilton, Canada.
Plast Surg (Oakv). 2025 Feb;33(1):59-67. doi: 10.1177/22925503231201634. Epub 2023 Sep 26.
Understanding opioid prescription, consumption, and the factors related to these is important to prescribe opioids responsibly. Our primary purpose is to determine the factors predicting opioid prescription, and the secondary purpose is to examine the factors predicting opioid tablet consumption. A prospective cohort was evaluated using 2 surveys. The primary outcome was type of prescription given (opioid vs non-opioid). The secondary outcome was the number of opioid tablets consumed at the second survey. Demographics, the pain catastrophizing scale, and patient health questionnaire-4 (PHQ-4) for depression and anxiety were collected. Statistics included Chi-Square, student's t-test, univariable, and multivariate regression analyses. Four hundred and forty patients completed the first survey, of which 193 completed the second. Two-hundred and fourteen (49%) patients received an opioid prescription. Opioids were given most often after: surgery in the main operating room (OR 23.6 [10.0-55.2]), breast or abdomen (OR 11.1 [1.2-101.1]), upper limb (OR 4.0 [1.7-9.3]), and less often after dermatologic surgery (OR 0.2 [0.1-0.5]). Among patients who received opioids, a mean of 10 opioid tablets were consumed at the post-operative survey. More tablets were consumed when: age was less than 60 ( < .05), with pre-operative opioid use ( = .03), and with a high score on the PHQ-4 ( = .002). The patterns of opioid prescription and consumption after outpatient Plastic Surgery are elucidated. Plastic surgeons over-estimate patients' opioid requirements. Potentially less opioids could be prescribed in the minor procedure room without an increase in pain crises. Public health campaigns should focus on the proper disposal of unused opioid tablets.
了解阿片类药物的处方、使用情况以及与之相关的因素对于合理开具阿片类药物处方非常重要。我们的主要目的是确定预测阿片类药物处方的因素，次要目的是研究预测阿片类药物片剂使用量的因素。使用两项调查对一个前瞻性队列进行了评估。主要结局是开具的处方类型（阿片类药物与非阿片类药物）。次要结局是第二次调查时服用的阿片类药物片剂数量。收集了人口统计学信息、疼痛灾难化量表以及用于评估抑郁和焦虑的患者健康问卷-4（PHQ-4）。统计分析包括卡方检验、学生t检验、单变量和多变量回归分析。440名患者完成了第一次调查，其中193名完成了第二次调查。214名（49%）患者接受了阿片类药物处方。阿片类药物最常在以下情况后开具：在主手术室进行手术（比值比[OR]23.6[10.0-55.2]）、乳房或腹部手术（OR 11.1[1.2-101.1]）、上肢手术（OR 4.0[1.7-9.3]），而在皮肤科手术后开具的频率较低（OR 0.2[0.1-0.5]）。在接受阿片类药物的患者中，术后调查时平均服用了10片阿片类药物。在以下情况下服用的片剂更多：年龄小于60岁（P<0.05）、术前使用阿片类药物（P = 0.03）以及PHQ-4得分较高（P = 0.002）。阐明了门诊整形手术后阿片类药物的处方和使用模式。整形外科医生高估了患者对阿片类药物的需求。在小手术室中可能可以减少阿片类药物的处方量，而不会增加疼痛危机。公共卫生运动应侧重于未使用阿片类药物片剂的妥善处理。
