Wide Variation and Excessive Dosage of Opioid Prescriptions for Common General Surgical Procedures
Wide Variation and Excessive Dosage of Opioid Prescriptions for Common General Surgical Procedures
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DOI：
10.1097/sla.0000000000001993
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发表时间：
2017-04-01
影响因子：
9
通讯作者：
Barth, Richard J. Jr
中科院分区：
文献类型：
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作者：
Hill, Maureen V.;McMahon, Michelle L.;Barth, Richard J. Jr
目的：研究阿片类药物处方模式后，普通外科手术程序，并估计一个理想的数量的药丸prescribed.Background：处方阿片类药物的转移是阿片类药物过量死亡率上升的主要原因。数据告知外科医生的阿片类药物的最佳剂量处方后，共同的普通外科programmes.Methods：我们评估了642例患者接受5个门诊程序：部分乳房切除术（PM），部分乳房切除术与前哨淋巴结活检（PM SLNB），腹腔镜胆囊切除术（LC），腹腔镜腹股沟疝修补术（LIH），开放式腹股沟疝修补术（IH）。将术后阿片类药物处方和再填充数据制表。进行了电话调查，以确定阿片类pills.Results的数量：有阿片类药物的处方接受相同的操作的患者的数量有很大的差异。规定的中位数（和范围）为：PM 20（0-50）、PM SLNB 20（0-60）、LC 30（0-100）、LIH 30（15-70）和IH 30（15-120）。只有28%的处方药被服用。该百分比因操作而异：PM 15%、PM SLNB 25%、LC 33%、LIH 15%和IH 31%。不到2%的患者获得了再填充。我们确定了能够完全满足80%接受每次手术的患者阿片类药物需求的药丸数量：PM 5，PM SLNB 10，LC 15，LIH 15和IH 15。如果这个数字被规定，阿片类药物最初规定的数量将是43%的实际数量prescribed.Conclusions：阿片类药物处方常见的普通外科手术程序有很大的变化。在许多情况下，过量的药丸被处方。使用我们的理想数字，外科医生可以充分治疗术后疼痛，并显着减少阿片类药物的处方数量。
Objective: To examine opioid prescribing patterns after general surgery procedures and to estimate an ideal number of pills to prescribe.Background: Diversion of prescription opioids is a major contributor to the rising mortality from opioid overdoses. Data to inform surgeons on the optimal dose of opioids to prescribe after common general surgical procedures is lacking.Methods: We evaluated 642 patients undergoing 5 outpatient procedures: partial mastectomy (PM), partial mastectomy with sentinel lymph node biopsy (PM SLNB), laparoscopic cholecystectomy (LC), laparoscopic inguinal hernia repair (LIH), and open inguinal hernia repair (IH). Postoperative opioid prescriptions and refill data were tabulated. A phone survey was conducted to determine the number of opioid pills taken.Results: There was a wide variation in the number of opioid pills prescribed to patients undergoing the same operation. The median number (and range) prescribed were: PM 20 (0-50), PM SLNB 20 (0-60), LC 30 (0-100), LIH 30 (15-70), and IH 30 (15-120). Only 28% of the prescribed pills were taken. This percentage varied by operation: PM 15%, PM SLNB 25%, LC 33%, LIH 15%, and IH 31%. Less than 2% of patients obtained refills. We identified the number of pills that would fully supply the opioid needs of 80% of patients undergoing each operation: PM 5, PM SLNB 10, LC 15, LIH 15, and IH 15. If this number were prescribed, the number of opioid initially prescribed would be 43% of the actual number prescribed.Conclusions: There is wide variability in opioid prescriptions for common general surgery procedures. In many cases excess pills are prescribed. Using our ideal number, surgeons can adequately treat postoperative pain and markedly decrease the number of opioids prescribed.