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针对阿片类药物处方的减肥手术:在减肥手术后有效减少阿片类药物使用的国家模型
Anthony T Petrick1, Tejen A Shah2, Dominick Gadaleta3
1Department of General Surgery, Geisinger Medical Center, Danville, Pennsylvania.
概括
一个国家协议成功地减少了减肥手术后的阿片类药物处方和使用. 然而,遵守放出后指导方针需要改进,以进一步减少与阿片类药物相关的死亡.
科学领域:
- 腹部外科 腹部外科
- 疼痛管理 疼痛管理
- 公共卫生 公共卫生
背景情况:
- 手术后的阿片类药物处方对美国与阿片类药物相关的死亡有显著的贡献.
- 慢性阿片类药物使用影响了手术后大约6%的阿片类药物未使用的患者,在减肥手术后可能翻一番.
研究的目的:
- 评估国家阿片类药物减少方案在减肥手术中的可行性和有效性.
- 评估该协议对住院和门诊阿片类药物消费的影响.
主要方法:
- 低血压手术向阿片类药物处方 (BSTOP) 协议在271个代谢和低血压手术认证和质量改进计划 (MBSAQIP) 认可的中心分三个阶段实施.
- 分析了关于协议遵守,住院阿片类药物使用 (MME) 和出院处方的数据.
主要成果:
- 在9项工艺措施中,在6项符合性方面观察到显著改善.
- 住院患者中位数的阿片类药物处方从35个MME下降到23个MME (P < .001).
- 出院时的阿片类药物处方减少了9.5% (P < .001),其中14.2%的医院实现了低入院MME处方,15.7%成为低出院处方者.
结论:
- 在减肥手术中实施国家阿片类药物减少协议是可行的,并且有效地制阿片类药物的处方和使用.
- 退院后处方指南的低采用率表明,目前仍有机会减轻处方阿片类药物对过量死亡的影响.
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