Postoperative Restrictive Opioid Protocols and Durable Changes in Opioid Prescribing and Chronic Opioid Use

被引：7

作者：

Zsiros, Emese ^{[1
,2
]}

Ricciuti, Jason ^{[2
,3
]}

Gallo, Steven ^{[4
]}

Argentieri, Deanna ^{[5
]}

Attwood, Kristopher ^{[6
]}

Ji, Wenyan ^{[7
]}

Hutson, Alan ^{[6
]}

Visco, Paul ^{[4
]}

Coffey, Devon ^{[8
]}

Riebandt, Grazyna ^{[5
]}

Mark, Jaron ^{[9
]}

Varghese, Aaron ^{[2
]}

Hess, Suzanne M. ^{[2
]}

Furlani, Thomas ^{[4
]}

Fabiano, Andrew ^{[10
]}

Hennon, Mark ^{[11
]}

Yendamuri, Sai ^{[11
]}

Kauffman, Eric C. ^{[12
]}

Wooten, Kimberly E. ^{[13
]}

Hicks, Wesley L. ^{[13
]}

Young, Jessica ^{[14
]}

Takabe, Kazuaki ^{[14
]}

Odunsi, Kunle ^{[15
]}

Case, Amy A. ^{[16
]}

Segal, Brahm H. ^{[17
]}

Johnson, Candace S. ^{[18
]}

Kuvshinoff, Boris ^{[14
]}

Nurkin, Steven ^{[14
]}

Paragh, Gyorgy ^{[19
]}

de Leon-Casasola, Oscar

机构：

[1] Roswell Park Comprehens Canc Ctr, Scott Bieler Clin Sci Ctr, Dept Gynecol Oncol, Elmand Carlton St, Buffalo, NY 14263 USA

[2] Roswell Park Comprehens Canc Ctr, Dept Gynecol Oncol, Buffalo, NY USA

[3] SSM Hlth, St Louis Univ Hosp, Dept Gynecol Oncol, St Louis, MO USA

[4] Roswell Park Comprehens Canc Ctr, Informat Technol, Buffalo, NY USA

[5] Roswell Park Comprehens Canc Ctr, Dept Pharm, Buffalo, NY USA

[6] Roswell Park Comprehens Canc Ctr, Biostat, Buffalo, NY USA

[7] Virginia Tech, Dept Biostat & Hlth Data Sci, Roanoke, VA USA

[8] SUNY Buffalo, Jacobs Sch Med & Biomed Sci, Buffalo, NY USA

[9] START Ctr Canc Care, San Antonio, TX USA

[10] Roswell Park Comprehens Canc Ctr, Neurooncol, Buffalo, NY USA

[11] Roswell Park Comprehens Canc Ctr, Thorac Surg, Buffalo, NY USA

[12] Roswell Park Comprehens Canc Ctr, Urol, Buffalo, NY USA

[13] Roswell Park Comprehens Canc Ctr, Head & Neck Surg, Buffalo, NY USA

[14] Roswell Park Comprehens Canc Ctr, Surg Oncol, Buffalo, NY USA

[15] Univ Chicago Med, Comprehens Canc Ctr, Dept Obstet & Gynecol, Chicago, IL USA

[16] Roswell Park Comprehens Canc Ctr, Support Care, Buffalo, NY USA

[17] Roswell Park Comprehens Canc Ctr, Dept Internal Med, Buffalo, NY USA

[18] Roswell Park Comprehens Canc Ctr, Pharmacol & Therapeut, Buffalo, NY USA

[19] Roswell Park Comprehens Canc Ctr, Dept Dermatol, Buffalo, NY USA

来源：

JAMA ONCOLOGY | 2023年 / 9卷 / 02期

基金：

美国国家卫生研究院;

关键词：

PAIN;

D O I：

10.1001/jamaoncol.2022.6278

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

Importance Changes in postsurgical opioid prescribing practices may help reduce chronic opioid use in surgical patients.Objective To investigate whether postsurgical acute pain across different surgical subspecialties can be managed effectively after hospital discharge with an opioid supply of 3 or fewer days and whether this reduction in prescribed opioids is associated with reduced new, persistent opioid use.Design, Setting, and ParticipantsIn this prospective cohort study with a case-control design, a restrictive opioid prescription protocol (ROPP) specifying an opioid supply of 3 or fewer days after discharge from surgery along with standardized patient education was implemented across all surgical services at a tertiary-care comprehensive cancer center. Participants were all patients who underwent surgery from August 1, 2018, to July 31, 2019.Main Outcomes and MeasuresMain outcomes were the rate of compliance with the ROPP in each surgical service, the mean number of prescription days and refill requests, type of opioid prescribed, and rate of conversion to chronic opioid use determined via a state-run opioid prescription program. Postsurgical complications were also measured.ResultsA total of 4068 patients (mean [SD] age, 61.0 [13.8] years; 2528 women [62.1%]) were included, with 2017 in the pre-ROPP group (August 1, 2018, to January 31, 2019) and 2051 in the post-ROPP group (February 1, 2019, to July 31, 2019). The rate of compliance with the protocol was 95%. After implementation of the ROPP, mean opioid prescription days decreased from a mean (SD) of 3.9 (4.5) days in the pre-ROPP group to 1.9 (3.6) days in the post-ROPP group (P < .001). The ROPP implementation led to a 45% decrease in prescribed opioids after surgery (mean [SD], 157.22 [338.06] mean morphine milligram equivalents [MME] before ROPP vs 83.54 [395.70] MME after ROPP; P < .001). Patients in the post-ROPP cohort requested fewer refills (367 of 2051 [17.9%] vs 422 of 2017 [20.9%] in the pre-ROPP cohort; P = .02). There was no statistically significant difference in surgical complications. The conversion rate to chronic opioid use decreased following ROPP implementation among both opioid-naive patients with cancer (11.3% [143 of 1267] to 4.5% [118 of 2645]; P < .001) and those without cancer (6.1% [19 of 310] to 2.7% [16 of 600]; P = .02).Conclusions and RelevanceIn this cohort study, prescribing an opioid supply of 3 or fewer days to surgical patients after hospital discharge was feasible for most patients, led to a significant decrease in the number of opioids prescribed after surgery, and was associated with a significantly decreased conversion to long-term opioid use without concomitant increases in refill requests or significant compromises in surgical recovery.

引用

页码：234 / 241

页数：8