Sarrami Shayan Mohammad, Buckner Nia, Murphy Kelly, James Isaac Bruce, Zhang Casey, Moroni Elizabeth, Reid Chanel, De La Cruz Carolyn
From the Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
Ann Plast Surg. 2025 Apr 1;94(4S Suppl 2):S229-S232. doi: 10.1097/SAP.0000000000004215.
Changing opiate prescribing practices in surgical fields without guidelines or standardizations can be a daunting task. An encouraging amount of literature has shown the benefits of reducing opioid use, but many plastic surgeons hesitate to initiate this directive. We present a practice modification designed to reduce the number of opiates prescribed and highlight the steps needed to implement a new prescribing algorithm.
In October of 2023, we implemented a new opiate algorithm for patients undergoing breast surgery. In the preintervention group, patients received 30 pills of postoperative opiates and recorded their consumption. Following the intervention, patients were given a maximum of 10 pills. To guide this new prescribing practice, we relied on pill consumption analysis from our preintervention group. In each cohort, data were collected on postoperative analgesic use per procedure.
Forty-one survey responses were included in our preintervention cohort and 10 in our postintervention cohort. A median of 5.5 pills was consumed by patients who received implant or tissue expanders, 4.75 pills for pedicled flaps, 12 pills for fat grafting, 5 pills for breast reduction, and 12.5 pills for gender affirming mastectomies. Before and after the intervention, median opiate consumption was similar at 6 pills and 5.5 pills, respectively. Patients in both cohorts would consume pills for a median of 4 days. In the preintervention group, patients had a median of 24 unused pills. This was significantly reduced to 0.5 unused pills in the postintervention cohort (P < 0.000). Refill requirements and analgesic use by the 2 groups was not significantly different (P = 0.063 and P = 0.545).
We have outlined a pathway for updating opioid prescribing algorithms in plastic surgery. Our opiate intervention significantly diminished opiate excess, reducing the risk for abuse. With growing research demonstrating the benefits of regulating prescriptions, and the best ways to implement change, surgeons can feel confident to just say yes to this meaningful reform.
在没有指导方针或标准化的情况下，改变外科领域的阿片类药物处方习惯可能是一项艰巨的任务。大量令人鼓舞的文献表明了减少阿片类药物使用的益处，但许多整形外科医生对启动这一指令仍犹豫不决。我们提出了一种旨在减少阿片类药物处方数量的实践改进方法，并强调实施新的处方算法所需的步骤。
2023年10月，我们为接受乳房手术的患者实施了一种新的阿片类药物算法。在干预前组，患者术后接受30片阿片类药物并记录其消耗量。干预后，患者最多可获得10片。为指导这种新的处方实践，我们依据干预前组的药物消耗分析。在每个队列中，收集了每个手术术后镇痛药物使用的数据。
干预前队列纳入了41份调查回复，干预后队列纳入了10份。接受植入物或组织扩张器的患者平均服用5.5片，带蒂皮瓣患者服用4.75片，脂肪移植患者服用12片，乳房缩小术患者服用5片，性别确认性乳房切除术患者服用12.5片。干预前后，阿片类药物的平均消耗量相似，分别为6片和5.5片。两个队列中的患者服用药物的平均天数均为4天。在干预前组，患者平均有24片未使用的药物。在干预后队列中，这一数字显著降至0.5片（P < 0.000）。两组的补充需求和镇痛药物使用没有显著差异（P = 0.063和P = 0.545）。
我们概述了整形外科中更新阿片类药物处方算法的途径。我们的阿片类药物干预显著减少了阿片类药物过量，降低了滥用风险。随着越来越多的研究表明规范处方的益处以及实施变革的最佳方法，外科医生可以放心地对这一有意义的改革说“是”。
