Abstract：
Opioids are commonly prescribed beyond what is necessary to adequately manage postoperative pain, increasing the likelihood of chronic opioid use, pill diversion, and misuse. We sought to assess opioid utilization and patient-reported outcomes (PROs) in patients undergoing ventral hernia repair (VHR) following the implementation of a patient-tailored opioid prescribing guideline.
A patient-tailored opioid prescribing guideline was implemented in March of 2018 for patients undergoing inpatient VHR in a large regional healthcare system. We retrospectively assessed opioid utilization and patient-reported outcomes among patients who did (n = 42) and did not receive guideline-based care (n = 121) between March 2018 and December 2019. PROs, operative details, and patient characteristics were extracted from the Abdominal Core Health Quality Collaborative (ACHQC) registry data, and length-of-stay and prescription information were extracted from the electronic health record system at the healthcare institution.
The milligram morphine equivalents (MME) prescribed at discharge was lower for patients receiving guideline-based care (Median = 65, interquartile range [IQR] = 50-75) than patients receiving standard care (Median = 100, IQR = 60-150). After adjusting for patient characteristics, the odds of receiving an opioid refill after discharge did not significantly differ between patient groups (P = 0.43). Patient Reported Outcomes Measurement Information System (PROMIS) pain scores and hernia-specific quality-of-life (HerQLes) scores at follow-up also did not differ between patients receiving guideline-based care (Mean PROMIS = 57.3; Mean HerQLes = 53.1) versus those that did not (Mean PROMIS = 56.7; Mean HerQLes = 46.6).
Patients who received tailored, guideline-based opioid prescriptions were discharged with lower opioid dosages and did not require more opioid refills than patients receiving standard opioid prescriptions. Additionally, we found no differences in pain or quality-of-life scores after discharge, indicating the opioids prescribed under the guideline were sufficient for patients.
A patient-tailored opioid prescribing guideline was implemented in March of 2018 for patients undergoing inpatient VHR in a large regional healthcare system. We retrospectively assessed opioid utilization and patient-reported outcomes among patients who did (n = 42) and did not receive guideline-based care (n = 121) between March 2018 and December 2019. PROs, operative details, and patient characteristics were extracted from the Abdominal Core Health Quality Collaborative (ACHQC) registry data, and length-of-stay and prescription information were extracted from the electronic health record system at the healthcare institution.
The milligram morphine equivalents (MME) prescribed at discharge was lower for patients receiving guideline-based care (Median = 65, interquartile range [IQR] = 50-75) than patients receiving standard care (Median = 100, IQR = 60-150). After adjusting for patient characteristics, the odds of receiving an opioid refill after discharge did not significantly differ between patient groups (P = 0.43). Patient Reported Outcomes Measurement Information System (PROMIS) pain scores and hernia-specific quality-of-life (HerQLes) scores at follow-up also did not differ between patients receiving guideline-based care (Mean PROMIS = 57.3; Mean HerQLes = 53.1) versus those that did not (Mean PROMIS = 56.7; Mean HerQLes = 46.6).
Patients who received tailored, guideline-based opioid prescriptions were discharged with lower opioid dosages and did not require more opioid refills than patients receiving standard opioid prescriptions. Additionally, we found no differences in pain or quality-of-life scores after discharge, indicating the opioids prescribed under the guideline were sufficient for patients.
摘要：
阿片类药物的处方通常超出了充分管理术后疼痛所必需的范围。增加长期使用阿片类药物的可能性，药丸转移，和误用。在实施患者定制的阿片类药物处方指南后，我们试图评估接受腹侧疝修补术（VHR）的患者的阿片类药物利用和患者报告的结果（PRO）。
针对患者量身定制的阿片类药物处方指南已于2018年3月在大型区域医疗保健系统中接受住院VHR的患者实施。我们回顾性评估了2018年3月至2019年12月期间接受过（n=42）和未接受基于指南的护理（n=121）的患者的阿片类药物利用和患者报告的结果。PROs,操作细节,从腹部核心健康质量协作(ACHQC)登记数据中提取患者特征，从医疗机构的电子健康记录系统中提取住院时间和处方信息。
接受基于指南的护理（中位数=65，四分位距[IQR]=50-75）的患者出院时处方的吗啡当量（MME）低于接受标准护理（中位数=100，IQR=60-150）的患者。在针对患者特征进行调整后,出院后接受阿片类药物补充的几率在患者组间无显著差异(P=0.43).患者报告的结果测量信息系统（PROMIS）疼痛评分和疝气特异性生活质量（HerQLes）评分在随访时在接受基于指南的护理的患者（平均PROMIS=57.3；平均HerQLes=53.1）与未接受的患者（平均PROMIS=56.7；平均HerQLes=46.6）之间也没有差异。
接受量身定制的患者，与接受标准阿片类药物处方的患者相比,基于指南的阿片类药物处方的阿片类药物剂量较低,因此不需要更多的阿片类药物补充.此外,我们发现出院后疼痛或生活质量评分没有差异，表明该指南规定的阿片类药物对患者足够.
针对患者量身定制的阿片类药物处方指南已于2018年3月在大型区域医疗保健系统中接受住院VHR的患者实施。
接受基于指南的护理（中位数=65，四分位距[IQR]=50-75）的患者出院时处方的吗啡当量（MME）低于接受标准护理（中位数=100，IQR=60-150）的患者。
接受量身定制的患者，
