A Standardized Protocol for Opioid Prescribing After Surgery Decreases Total Morphine Equivalents Prescribed.

Autor:	Millard JL; Prisma Health- Upstate, Department of General Surgery, Greenville Memorial, Greenville, SC, USA., Hahn EA; University of South Carolina School of Medicine-Greenville, Greenville, SC, USA., Schumann E; University of South Carolina School of Medicine-Greenville, Greenville, SC, USA., Register L; University of South Carolina School of Medicine-Greenville, Greenville, SC, USA., Blackhurst D; Prisma Health- Upstate, Department of General Surgery, Greenville Memorial, Greenville, SC, USA., Carbonell AM; Prisma Health- Upstate, Department of General Surgery, Greenville Memorial, Greenville, SC, USA.; University of South Carolina School of Medicine-Greenville, Greenville, SC, USA., Cobb WS; Prisma Health- Upstate, Department of General Surgery, Greenville Memorial, Greenville, SC, USA.; University of South Carolina School of Medicine-Greenville, Greenville, SC, USA., Warren JA; Prisma Health- Upstate, Department of General Surgery, Greenville Memorial, Greenville, SC, USA.; University of South Carolina School of Medicine-Greenville, Greenville, SC, USA.
Jazyk:	angličtina
Zdroj:	The American surgeon [Am Surg] 2023 Sep; Vol. 89 (9), pp. 3771-3777. Date of Electronic Publication: 2023 May 17.
DOI:	10.1177/00031348231175494
Abstrakt:	Introduction: Perioperative opioid analgesia has been extensively reexamined during the opioid epidemic. Multiple studies have demonstrated over prescription of opioids, demonstrating the need for change in prescribing practices. A standard opioid prescribing protocol was implemented to evaluate opioid prescribing trends and practices. Objectives: To evaluate opioid use after primary ventral, inguinal, and incisional hernia repair and to assess clinical factors that may impact opioid prescribing and consumption. Secondary outcomes include the number of refills, patients without opioid requirement, difference in opioid use based on patient characteristics and adherence to prescribing protocol. Methods: This is a prospective observational study examining patients undergoing inguinal, primary ventral and incisional hernias between February and November 2019. A standardized prescribing protocol was implemented and utilized for postoperative prescribing. All data was captured in the abdominal core health quality collaborative (ACHQC) and opioid use was standardized via morphine milligram equivalents (MME). Results: 389 patients underwent primary ventral, incisional, and inguinal hernia repair, with a total of 285 included in the final analysis. 170 (59.6%) of patients reported zero opioid use postoperatively. Total opioid MME prescribed and high MME consumption were significantly higher after incisional hernia repair with a greater number of refills were required. Compliance with prescribing protocol resulted in lower MME prescription, but not actual lower MME consumption. Conclusions: Implementation of a standardized protocol for opioid prescribing after surgery decreases the total MME prescribed. Compliance with our protocol significantly reduced this disparity, which has the potential for decreasing abuse, misuse, and diversion of opioids by better estimating actual postoperative analgesic requirements. Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Databáze:	MEDLINE
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