本研究的目的是在指导规范处方和高度浪费防止情况下，确定手术后长期给予阿片类药物处方的频率和原因。尽管之前的研究显示，5%至10%的手术后阿片类药物处方患者将在手术后长达3至12个月接受阿片类药物处方，但人们对为何长期给予阿片类药物处方知之甚少。我们对221名手术病人进行了研究，这些病人参加了先前报道的前瞻性临床试验，采用了以患者为中心的指南进行出院时关于阿片类药物处方的建议，并实现了高度防止浪费。这些病人接受了广泛的治疗服务；88%的个体接受了癌症相关手术。使用处方药监测程序搜索识别长期给予阿片类药物处方，通过医疗记录审核确定给药的原因和阿片类药物不良事件。我们采用共识定义来确定持续性的阿片类药物使用：手术后3至12个月和持续供应大于60天。15.3%（34/221）的病人在手术后3至12个月内接受了阿片类药物处方，其中5.4%和12.2%的人在手术后3至6个月和6至12个月内接受了处方。每名患者的阿片类药物处方天数中位数为7，四分位数范围为5至27，范围为1至447天。长期给予阿片类药物处方的原因是：51%是因为新的疼痛性疾病，40%是因为新的手术，6%与指数手术有关；只有1名患者在1次情况下因为非特定原因被给予了阿片类药物处方。五名患者（2.3%）出现持续性阿片类药物使用，其中2名由于恶性肿瘤的疼痛，2名由于新的医疗状况，1名由于慢性脓肿。在一个前瞻性研究的阿片类药物处方患者组中，这些病人接受了指南规范的阿片类药物处方和高度防止浪费率的处置后，没有患者仅因手术后的药物处方而成为持续性阿片类药物使用者。长期给予阿片类药物处方的原因是其他明确定义的医疗或手术原因。版权所有©2021 Wolters Kluwer Health, Inc.。保留所有权利。

The aim of this study was to determine the frequency and reasons for long-term opioid prescriptions (rxs) after surgery in the setting of guideline-directed prescribing and a high rate of excess opioid disposal.Although previous studies have demonstrated that 5% to 10% of opioid-naïve patients prescribed opioids after surgery will receive long-term (3-12 months after surgery) opioid rxs, little is known about the reasons why long-term opioids are prescribed.We studied 221 opioid-naïve surgical patients enrolled in a previously reported prospective clinical trial which used a patient-centric guideline for discharge opioid prescribing and achieved a high rate of excess opioid disposal. Patients were treated on a wide variety of services; 88% of individuals underwent cancer-related surgery. Long-term opioid rxs were identified using a Prescription Drug Monitoring Program search and reasons for rxs and opioid adverse events were ascertained by medical record review. We used a consensus definition for persistent opioid use: opioid rx 3 to 12 months after surgery and >60day supply.15.3% (34/221) filled an opioid rx 3 to 12 months after surgery, with 5.4% and 12.2% filling an rx 3 to 6 and 6 to 12 months after surgery, respectively. The median opioid rx days supply per patient was 7, interquartile range 5 to 27, range 1 to 447 days. The reasons for long-term opioid rxs were: 51% new painful medical condition, 40% new surgery, 6% related to the index operation; only 1 patient on 1 occasion was given an opioid rx for a nonspecific reason. Five patients (2.3%) developed persistent opioid use, 2 due to pain from recurrent cancer, 2 for new medical conditions, and 1 for a chronic abscess.In a group of prospectively studied opioid-naïve surgical patients discharged with guideline-directed opioid rxs and who achieved high rates of excess opioid disposal, no patients became persistent opioid users solely as a result of the opioid rx given after their index surgery. Long-term opioid use did occur for other, well-defined, medical or surgical reasons.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.