Opioid Use and Storage Patterns by Patients after Hospital Discharge following Surgery
Opioid Use and Storage Patterns by Patients after Hospital Discharge following Surgery
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DOI：
10.1371/journal.pone.0147972
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发表时间：
2016-01-29
期刊：
影响因子：
3.7
通讯作者：
Binswanger, Ingrid A.
中科院分区：
文献类型：
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作者：
Bartels, Karsten;Mayes, Lena M.;Binswanger, Ingrid A.
简介基于阿片类药物的镇痛疗法是手术后疼痛管理的基石。最近阿片类药物销售和阿片类药物过量的增加表明，最大限度地提高手术后阿片类药物处方的安全性非常重要。鉴于患者可能与其他家庭成员住在家里，出院后安全储存和适当处置多余的阿片类药物对于防止意外的二次暴露是必要的。识别手术后可能服用过量阿片类药物的患者的特征可能有助于更有针对性的处方实践和安全干预。我们的研究旨在阐明剖腹产（C-section）和胸外科手术后出院患者中患者报告的阿片类药物使用模式和家庭阿片类药物储存模式。具体来说，我们试图确定出院后使用大约一半或更多与更少处方阿片类药物的患者的特征。方法在这项队列研究中，我们开展了一项关于出院后镇痛质量、相对于处方量服用阿片类药物的量、不服用所有处方药物的原因以及剩余阿片类药物的储存和处置方法的调查。在三级学术医疗中心接受剖腹产或胸部手术的成年患者出院后接受了基于网络的自我管理调查。描述性统计（平均值和标准差、比例）用于描述研究样本和调查结果。出院后使用不成对 t 检验、曼-惠特尼检验和卡方检验，对报告服用约一半或更多与较少处方阿片类药物的患者进行比较。结果大多数 (53%) 剖腹产后 (N = 30) 的受访者报告没有服用或服用很少（少于 5 粒）处方阿片类药物； 83% 的受访者表示服用了一半或更少； 17% 的女性表示服用了全部或几乎全部（剩余 5 粒或更少的药片）阿片类药物处方。在胸外科手术后的一组患者中 (n = 31)，45% 的患者报告没有服用或服用极少数（5 颗或更少）处方阿片类药物； 71% 的人表示服用了一半或更少； 29% 的患者报告服用了全部或几乎全部（剩余 5 粒或更少的阿片类药物）处方。在这两个队列中，出院后报告使用约一半或更多处方阿片类药物的组在住院期间使用阿片类药物的比例较高。剖腹产手术和胸外科手术后剩余的阿片类药物分别存放在未上锁的位置，占 77% 和 73%。结论我们对同一学术医疗中心的两个不同患者群体进行的调查结果表明，目前剖腹产和胸科手术后出院疼痛管理的阿片类药物处方做法可能无法考虑到个别患者的镇痛需求。过量的阿片类药物药丸通常储存在不安全的地方，是非医疗阿片类药物使用的潜在来源，并导致患者及其家人出现相关的发病率和死亡率。需要开展研究，制定以目标为导向、以患者为中心的出院后阿片类药物处方实践，并鼓励手术后阿片类药物的安全实践。
IntroductionOpioid-based analgesic therapy represents a cornerstone of pain management after surgery. The recent rise in opioid sales and opioid overdoses suggests it is important to maximize the safety of opioid prescribing after surgery. Given that patients may live with other family members in the home, safe storage and appropriate disposal of excess opioids after hospital discharge are necessary to prevent unintended secondary exposures. Identifying characteristics of patients who are likely to be prescribed excess opioids after surgery may enable more targeted prescription practices and safety interventions. Our study aimed to elucidate patient-reported opioid use patterns and modes of home storage of opioids among patients discharged home after Cesarean section (C-section) and thoracic surgery. Specifically, we sought to identify characteristics of patients who reported using about half or more versus less of the opioids prescribed to them for use after hospital discharge.MethodsFor this cohort study, we developed a survey on quality of analgesia following hospital discharge, amounts of opioids taken relative to the amount prescribed, reasons for not taking all prescribed medications, and storage and disposal methods for leftover opioids. Adult patients, who had C-section or thoracic surgery at a tertiary academic medical center, were given a web-based self-administered survey after discharge. Descriptive statistics (means and standard deviations, proportions) were used to describe the study sample and survey results. Comparisons between patients who reported taking about half or more versus less of the opioids prescribed to them for use after hospital discharge were made using unpaired t-tests, Mann-Whitney tests, and Chi-square tests as appropriate.ResultsThe majority (53%) of respondents after C-section (N = 30) reported taking either no or very few (less than 5) prescribed opioid pills; 83% reported taking half or less; and 17% of women, reported taking all or nearly all (5 or fewer pills left over) of their opioid prescription. In a cohort of patients after thoracic surgery (n = 31) 45% reported taking either no or very few (5 or less) prescribed opioid pills; 71% reported taking half or less; and 29% of patients reported taking all or nearly all (5 or fewer pills left over) of their opioid prescription. In both cohorts, use of opioids while hospitalized was higher in the group reporting using about half or more of prescribed opioids after discharge. Leftover opioids were stored in an unlocked location in 77% and 73% of cases following C-section and thoracic surgery, respectively.ConclusionOur findings from surveys in two distinct patient populations at a single academic medical center suggest that current opioid prescribing practices for pain management at hospital discharge following Cesarean section and thoracic surgery may not account for individual patients' analgesic requirements. Excess opioid pills are commonly stored in unsecured locations and represent a potential source for non-medical opioid use and associated morbidity and mortality in patients and their families. Research to develop goal-directed and patient-centered post-discharge opioid prescription practices and encourage opioid safety practices after surgery is needed.