Wide Variation and Overprescription of Opioids After Elective Surgery
Wide Variation and Overprescription of Opioids After Elective Surgery
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DOI：
10.1097/sla.0000000000002365
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发表时间：
2017-10-01
影响因子：
9
通讯作者：
Habermann, Elizabeth B.
中科院分区：
文献类型：
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作者：
Thiels, Cornelius A.;Anderson, Stephanie S.;Habermann, Elizabeth B.
目的：我们的目的是确定阿片类药物处方的做法在外科专业和institutions.Background：在努力减少处方麻醉药的全国阿片类药物流行的贡献，减少术后阿片类药物处方已被提出。有人建议，最多7天，或200毫克口服吗啡当量（OME），应规定在阿片类药物初治patients.Methods出院：成人接受25个常见的选择性程序，从2013年至2015年确定美国外科医师学会国家外科手术质量改进计划的数据从3个学术中心在明尼苏达州，亚利桑那州和佛罗里达。从药房数据中提取出院时处方的阿片类药物并转换为OME。Wilcoxon秩和检验和KruskalWallis测试评估variation.Results：在7651例患者中，93.9%的患者在出院时接受阿片类药物处方。在接受阿片类药物处方的7181例患者中，处方的中位数为375 OME（四分位数范围225-750）。中位OME因性别而异（375例男性vs 390例女性，P = 0.002），并随年龄增长而增加（375例18-39岁至425例80岁以上，P < 0.001）。肥胖患者和非癌症诊断患者接受更多阿片类药物（均P < 0.001）。对5756例（75.2%）阿片类药物初治患者的亚组分析显示，大多数患者接受了> 200次OME（80.9%）。阿片类药物处方的做法显着变化，看到每个程序和3个医疗centers.Conclusions之间：大多数患者过量阿片类药物。存在无法用患者因素解释的显著处方变化。这些数据将指导手术后优化阿片类药物处方的实践。
Objective: We aimed to identify opioid prescribing practices across surgical specialties and institutions.Background: In an effort to minimize the contribution of prescription narcotics to the nationwide opioid epidemic, reductions in postoperative opioid prescribing have been proposed. It has been suggested that a maximum of 7 days, or 200mg oral morphine equivalents (OME), should be prescribed at discharge in opioid-naive patients.Methods: Adults undergoing 25 common elective procedures from 2013 to 2015 were identified from American College of Surgeons National Surgical Quality Improvement Program data from 3 academic centers in Minnesota, Arizona, and Florida. Opioids prescribed at discharge were abstracted from pharmacy data and converted into OME. Wilcoxon Rank-Sum and KruskalWallis tests assessed variations.Results: Of 7651 patients, 93.9% received opioid prescriptions at discharge. Of 7181 patients who received opioid prescriptions, a median of 375 OME (interquartile range 225-750) were prescribed. Median OME varied by sex (375 men vs 390 women, P = 0.002) and increased with age (375 age 18-39 to 425 age 80+, P < 0.001). Patients with obesity and patients with non-cancer diagnoses received more opioids (both P < 0.001). Subset analysis of the 5756 (75.2%) opioid-naive patients showed the majority received > 200 OME (80.9%). Significant variations in opioid prescribing practices were seen within each procedure and between the 3 medical centers.Conclusions: The majority of patients were overprescribed opioids. Significant prescribing variation exists that was not explained by patient factors. These data will guide practices to optimize opioid prescribing after surgery.