Evidence-based opioid prescribing guidelines after lung resection: a prospective, multicenter analysis.

Autor:	Mondoñedo JR; Department of Surgery, University of Michigan, Ann Arbor, MI, USA., Brescia AA; Department of Surgery, University of Michigan, Ann Arbor, MI, USA., Clark MJ; Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, MI, USA., Chang ML; Department of Surgery, University of Michigan, Ann Arbor, MI, USA., Jiang S; Department of Surgery, University of Michigan, Ann Arbor, MI, USA., He C; Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, MI, USA., Welsh RJ; Beaumont Hospital, Royal Oak, MI, USA.; Beaumont Hospital, Troy, MI, USA., Popoff AM; Henry Ford Hospital, Detroit, MI, USA., Kulkarni MG; Henry Ford Allegiance Health, Jackson, MI, USA., Lall SC; Munson Medical Center, Traverse City, MI, USA., Pratt JW; Ascension Borgess Hospital, Kalamazoo, MI, USA., Adams KN; St. Joseph Mercy Ann Arbor, Ypsilanti, MI, USA., Alnajjar RM; Henry Ford Macomb Hospital, Clinton Township, MI, USA., Martin JR; McLaren Port Huron Hospital, Port Huron, MI, USA., Gandhi DB; McLaren Greater Lansing, Lansing, MI, USA., Brummett CM; Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA., Chang AC; Department of Surgery, University of Michigan, Ann Arbor, MI, USA., Lagisetty KH; Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
Jazyk:	angličtina
Zdroj:	Journal of thoracic disease [J Thorac Dis] 2023 Jun 30; Vol. 15 (6), pp. 3285-3294. Date of Electronic Publication: 2023 Jun 21.
DOI:	10.21037/jtd-22-1621
Abstrakt:	Background: Opioid prescribing guidelines have significantly decreased overprescribing and post-discharge use after cardiac surgery; however, limited recommendations exist for general thoracic surgery patients, a similarly high-risk population. We examined opioid prescribing and patient-reported use to develop evidence-based, opioid prescribing guidelines after lung cancer resection. Methods: This prospective, statewide, quality improvement study was conducted between January 2020 to March 2021 and included patients undergoing surgical resection of a primary lung cancer across 11 institutions. Patient-reported outcomes at 1-month follow-up were linked with clinical data and Society of Thoracic Surgery (STS) database records to characterize prescribing patterns and post-discharge use. The primary outcome was quantity of opioid used after discharge; secondary outcomes included quantity of opioid prescribed at discharge and patient-reported pain scores. Opioid quantities are reported in number of 5-mg oxycodone tablets (mean ± standard deviation). Results: Of the 602 patients identified, 429 met inclusion criteria. Questionnaire response rate was 65.0%. At discharge, 83.4% of patients were provided a prescription for opioids of mean size 20.5±13.1 pills, while patients reported using 8.2±13.0 pills after discharge (P<0.001), including 43.7% who used none. Those not taking opioids on the calendar day prior to discharge (32.4%) used fewer pills (4.4±8.1 vs. 11.7±14.9, P<0.001). Refill rate was 21.5% for patients provided a prescription at discharge, while 12.5% of patients not prescribed opioids at discharge required a new prescription before follow-up. Pain scores were 2.4±2.5 for incision site and 3.0±2.8 for overall pain (scale 0-10). Conclusions: Patient-reported post-discharge opioid use, surgical approach, and in-hospital opioid use before discharge should be used to inform prescribing recommendations after lung resection. Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-22-1621/coif). RMA reports grants and travel expenses when proctoring for Edwards Lifesciences, Intuitive Surgical, and Ethicon – Johnson & Johnson. JR Martin reports consulting fees and webinars for Terumo. CMB reports consulting fees from Heron Therapeutics, Vertex Pharmaceuticals, Benter Foundation, and Alosa Health, as well as receiving payment for providing expert testimony. ACC previously served as the President of the Michigan Society of Thoracic & Cardiovascular Surgeons. The other authors have no conflicts of interest to declare. (2023 Journal of Thoracic Disease. All rights reserved.)
Databáze:	MEDLINE
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