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首页> 外文期刊>Urology practice. >Inpatient Opioid Use Poorly Predicts Discharge Opioid Prescriptions Following Nephrectomy
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Inpatient Opioid Use Poorly Predicts Discharge Opioid Prescriptions Following Nephrectomy

机译：住院表阿片类药物使用不良预测肾切除术后放电阿片类药物处方

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Introduction: The overprescribing of opioids after urological surgery places patients at risk for opioid overuse and dependency. However, few guidelines exist to help urologists consistently prescribe appropriate quantities of pain medications. We sought to characterize the variation in opioid prescribing habits at time of discharge following nephrectomy.Methods: We performed a retrospective review of patients who underwent partial or radical nephrectomy between November 2016 and May 2018 at an academic medical center. We reviewed patient, procedure and provider level variables potentially associated with high opioid use. Daily inpatient opioid use and discharge opioid prescriptions were tabulated in oral morphine equivalents.Results: We identified 173 eligible patients who used a daily average of 36 oral morphine equivalents during their hospitalization weaning to 27 oral morphine equivalents on the day of discharge. All but 2 patients were prescribed opioids at discharge with an average of 367 oral morphine equivalents per prescription (SD 284). On multiple linear regression preoperative opioid use, open vs minimally invasive approach, length of stay and last day opioid use were associated with discharge oral morphine equivalents (R2=0.51, p <0.05).Conclusions: Patients were discharged with excessive opioids with an average discharge prescription equivalent to 13.6 times the last inpatient day's use. When combined with other potential predictors of discharge opioid prescriptions inpatient use accounts for less than 50% of the variance between prescriptions. Systems are needed to help minimize variability in opioid prescribing practices and reduce the overall quantity prescribed.
机译：导言：泌尿外科手术后过量使用阿片类药物会使患者面临阿片类药物过度使用和依赖的风险。然而，很少有指导方针能帮助泌尿科医生持续开出适量的止痛药。我们试图描述肾切除术后出院时阿片类药物处方习惯的变化。方法：我们对2016年11月至2018年5月在一家学术医学中心接受部分或根治性肾切除术的患者进行了回顾性分析。我们回顾了可能与高阿片类药物使用相关的患者、手术和提供者水平变量。每日住院患者阿片类药物的使用和出院阿片类药物的处方以口服吗啡当量的形式制成表格。结果：我们确定了173名符合条件的患者，他们在住院期间平均每天使用36种口服吗啡当量，在出院当天断奶至27种口服吗啡当量。除2名患者外，所有患者在出院时均服用阿片类药物，每份处方平均367片口服吗啡当量（SD 284）。在多元线性回归分析中，术前阿片类药物的使用、开放式与微创手术方式、住院时间和最后一天阿片类药物的使用与出院时口服吗啡当量有关（R2=0.51，p<0.05）。结论：患者出院时服用过量阿片类药物，平均出院处方相当于最后住院日使用量的13.6倍。当与出院阿片类药物处方的其他潜在预测因素相结合时，住院患者使用阿片类药物的比例不到处方间差异的50%。需要系统来帮助最大限度地减少阿片类药物处方实践的可变性，并减少总的处方量。

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