Variation of Opioid Prescribing Patterns among Patients undergoing Similar Surgery on the Same Acute Care Surgery Service of the Same Institution: Time for Standardization?
Variation of Opioid Prescribing Patterns among Patients undergoing Similar Surgery on the Same Acute Care Surgery Service of the Same Institution: Time for Standardization?
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DOI：
10.1016/j.surg.2018.05.047
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发表时间：
2018-11-01
期刊：
影响因子：
3.8
通讯作者：
Kaafarani, Haytham M. A.
中科院分区：
文献类型：
--
作者：
Eid, Ahmed I.;DePesa, Christopher;Kaafarani, Haytham M. A.
背景：未使用的处方阿片类药物的转移是目前美国阿片类药物流行的主要原因。我们的目的是研究阿片类药物处方在急诊surgery.Methods的变化：2016年10月至2017年3月期间，所有接受腹腔镜阑尾切除术，腹腔镜胆囊切除术，或腹股沟疝修补术的急性护理手术服务的1个学术中心的患者被纳入。对于每例患者，我们系统地审查了电子病历和处方药房平台，以确定：（1）阿片类药物滥用史，（2）术前3个月阿片类药物摄入，（3）处方阿片类药物数量，（4）非阿片类止痛药处方（例如，对乙酰氨基酚、布洛芬），以及（5）阿片类药物处方续药需求。阿片类药物处方的平均值和范围，以及他们的口服吗啡当量，calculated.Results：共255例（43.5%腹腔镜阑尾切除术，44.3%腹腔镜胆囊切除术，12.1%腹股沟疝修补术）。平均年龄为47.5岁，52.1%为女性，11.4%有阿片类药物使用史，92.5%在出院时接受阿片类药物处方。只有70.9%的患者被告知使用非阿片类止痛药。阿片类药物处方的平均值和范围为17.4; 0-56（腹腔镜阑尾切除术）、17.1; 0-75（腹腔镜胆囊切除术）和20.9; 0-50（腹股沟疝修补术），而处方的口服吗啡当量范围为0-600 mg（腹腔镜阑尾切除术/腹腔镜胆囊切除术）和0-375 mg（腹股沟疝修补术）。没有病人需要任何阿片类药物refills.Conclusion：即使在同一外科服务，阿片类药物处方的变化很大。规范疼痛管理的指南可能有助于防止阿片类药物过度处方。(C)2018爱思唯尔公司All rights reserved.
Background: Diversion of unused prescription opioids is a major contributor to the current United States opioid epidemic. We aimed to study the variation of opioid prescribing in emergency surgery.Methods: Between October 2016 and March 2017, all patients undergoing laparoscopic appendectomy, laparoscopic cholecystectomy, or inguinal hernia repair in the acute care surgery service of 1 academic center were included. For each patient, we systematically reviewed the electronic medical record and the prescribing pharmacy platform to identify: (1) history of opioid abuse, (2) opioid intake 3 months preoperatively, (3) number of opioid pills prescribed, (4) prescription of nonopioid pain medications (eg, acetaminophen, ibuprofen), and (5) the need for opioid prescription refills. The mean and range of opioid pills prescribed, as well as their oral morphine equivalent, were calculated.Results: A total of 255 patients were included (43.5% laparoscopic appendectomy, 44.3% laparoscopic cholecystectomy, and 12.1% inguinal hernia repair). The mean age was 47.5 years, 52.1% were female, 11.4% had a history of opioid use, and 92.5% received opioid prescriptions upon hospital discharge. Only 70.9% of patients were instructed to use nonopioid pain medications. The mean and range of opioid pills prescribed were 17.4; 0-56 (laparoscopic appendectomy), 17.1; 0-75 (laparoscopic cholecystectomy), and 20.9; 0-50 (inguinal hernia repair), while the range of prescribed oral morphine equivalent was 0-600 mg for laparoscopic appendectomy/laparoscopic cholecystectomy and 0-375 mg for inguinal hernia repair. No patients required any opioid medication refills.Conclusion: Even within the same surgical service, wide variation of opioid prescription was observed. Guidelines that standardize pain management may help prevent opioid overprescribing. (C) 2018 Elsevier Inc. All rights reserved.