手术后鸦片类处方可能导致恢复延迟、围手术期并发症、鸦片类使用障碍和过度开具鸦片类处方转移，从而使社区面临鸦片类误用或成瘾的风险。本研究旨在评估一种消除重大泌尿癌手术出院后鸦片类处方的方案。在三级转诊中心，于2017年5月至2021年6月开展了无鸦片类处方出院手术（NOPIOIDS）方案的队列研究。将行开膀胱式或微创性根治性切除术、根治性或部分性肾切除术和根治性前列腺切除术的患者分为对照组（通常鸦片类处方）、引导组（减少鸦片类处方）和NOPIOIDS组（无鸦片类处方）。NOPIOIDS组接受住院前教育手册、出院后使用非鸦片类镇痛剂的说明书和无常规鸦片类处方。引导组在处方者自行决定的情况下，接受出院后的说明并减少鸦片类处方。对照组在处方者自行决定的情况下，接受鸦片类处方。 主要结局指标包括出院及出院后30天内开具鸦片类处方的频率和剂量。其他结果指标包括患者报告的疼痛和满意度水平、计划外的医疗利用率和手术后并发症。在647名鸦片类用量低的患者（平均[SD]年龄为63.6[10.0]岁；男性478名[73.9%]；白人586名[90.6%]）中，对照组、引导组和NOPIOIDS组在出院处方方面的比率分别为80.9%（194名中的157名）、57.9%（95名中的55名）和2.2%（358名中的8名）（中位数的Kruskal-Wallis检验：P < 0.001），总体中位数（IQR）处方的片数分别是对照组、引导组和NOPIOIDS组的14（10-20）、4（0-5.3）和0（0-0）片/患者，对应的中位数（IQR）剂量分别为14（10-20），4（0-5.3）和0（0-0）片/患者（中位数的Kruskal-Wallis检验：P < 0.001）。在NOPIOIDS组中，除肾脏手术外，所有类型手术的鸦片类中位数和均值剂量均为0（均值[SD]为0.5 [1.7]片）。NOPIOIDS组共收到358位（72.6%）患者的疼痛调查，疼痛评分低（平均[SD]为2.5 [0.86]），满意度评分高（平均[SD]为86.6 [3.8]）。没有增加无鸦片类处方组的术后并发症。 这种围手术期方案重点强调非鸦片类替代方案和患者说明书，在几乎不影响疼痛控制、并发症或恢复的情况下，可能安全有效地消除重大腹盆癌手术后的鸦片类处方需求。

Postoperative opioid prescriptions are associated with delayed recovery, perioperative complications, opioid use disorder, and diversion of overprescribed opioids, which places the community at risk of opioid misuse or addiction.To assess a protocol for eliminating postdischarge opioid prescriptions after major urologic cancer surgery.This cohort study of the no opioid prescriptions at discharge after surgery (NOPIOIDS) protocol was conducted between May 2017 and June 2021 at a tertiary referral center. Patients undergoing open or minimally invasive radical cystectomy, radical or partial nephrectomy, and radical prostatectomy were sorted into the control group (usual opioids), the lead-in group (reduced opioids), and the NOPIOIDS group (no opioid prescriptions).The NOPIOIDS group received a preadmission educational handout, postdischarge instructions for using nonopioid analgesics, and no routine opioid prescriptions. The lead-in group received a postdischarge instruction sheet and reduced opioid prescriptions at prescribers' discretion. The control group received opioid prescriptions at prescribers' discretion.Primary outcome measures included rate and dose of opioid prescriptions at discharge and for 30 days postdischarge. Additional outcome measures included patient-reported pain and satisfaction level, unplanned health care utilization, and postoperative complications.Of 647 opioid-naive patients (mean [SD] age, 63.6 [10.0] years; 478 [73.9%] male; 586 [90.6%] White), the rate of opioid prescriptions at discharge for the control, the lead-in, and the NOPIOIDS groups was 80.9% (157 of 194), 57.9% (55 of 95), and 2.2% (8 of 358) (Kruskal-Wallis test of medians: P < .001), and the overall median (IQR) tablets prescribed was 14 (10-20), 4 (0-5.3), and 0 (0-0) per patient in the control, lead-in, and NOPIOIDS groups, respectively (Kruskal-Wallis test of medians: P < .001). In the NOPIOIDS group, median and mean opioid dose was 0 tablets for all procedure types, with the exception of kidney procedures (mean [SD], 0.5 [1.7] tablets). Patient-reported pain surveys were received from 358 patients (72.6%) in the NOPIOIDS group, demonstrating low pain scores (mean [SD], 2.5 [0.86]) and high satisfaction scores (mean [SD], 86.6 [3.8]). There was no increase in postoperative complications in the group with no opioid prescriptions.This perioperative protocol, with emphasis on nonopioid alternatives and patient instructions, may be safe and effective in nearly eliminating the need for opioid prescriptions after major abdominopelvic cancer surgery without adversely affecting pain control, complications, or recovery.