Importance Over the past 20 years, opioid misuse and opioid addiction have risen to epidemic proportions in the United States. One-third of adults receiving long-term opioid therapy report that their first opioid prescription came from a surgeon, indicating that postsurgical prescribing is an important point of intervention in the opioid epidemic. Such interventions differ from historical interventions on prescribing in that they must be closely monitored to ensure pain continues to be adequately controlled after surgical procedures. As evidence on nonopioid-based pain control grows, a key question is how to implement practice change in postsurgical discharge prescribing.

Objective To examine interventions associated with changing opioid prescription practices on surgical discharge.

Evidence Review Studies published after 2000 that included interventions that aimed at postsurgical opiate stewardship and evaluated outcomes were included. PubMed and Embase were searched through March 2018 for relevant articles, with additional articles retrieved based on citations in articles retrieved in the initial search. Quality was assessed by 2 independent reviewers using the Quality Assessment Tool for Quantitative Studies, and quality scores were reconciled through discussion and mutual agreement.

Findings Eight studies met inclusion criteria, of which 3 were preintervention and postintervention comparison studies, 3 were controlled clinical studies, 1 was a time-series study, and 1 compared postintervention results with a predetermined baseline. Interventions done at the organization level, including changes to electronic health records order sets and workflow, showed clear positive results. Additionally, 2 studies that centered on developing guidelines based on actual patient opioid use and disseminating these guidelines to clinicians reported reductions up to 53% in the quantity prescribed. No increases in emergency department visits or refill requests were reported in studies measuring these outcomes. However, 1 study focused on reducing the number of children who were prescribed codeine found via check-in telephone calls that 13 of 240 patients (5.4%) had inadequately controlled pain.

Conclusions and Relevance The studies reviewed provide evidence that clinician-mediated and organizational-level interventions are powerful tools in creating change in postsurgical opioid prescribing. This summary highlights paucity of high-quality studies that provide clear evidence on the most effective intervention at reducing postoperative opioid prescribing.

重要性 在过去的20年中，阿片类药物滥用和阿片类药物成瘾在美国已上升为流行病。接受长期阿片类药物治疗的成年人中，有三分之一的人报告说他们的第一个阿片类药物处方来自外科医生，这表明术后处方是干预阿片类药物流行的重要方法。此类干预措施与以往的处方干预措施不同，在于必须密切监测它们，以确保在手术后仍能继续适当控制疼痛。随着基于非阿片类药物的疼痛控制的证据越来越多，一个关键的问题是如何在术后出院处方中实施实践改变。

目的 探讨与改变手术出院阿片类药物处方实践有关的干预措施。

2000年后发表的证据回顾研究包括针对阿片类药物术后管理和评估结果的干预措施。截至2018年3月，已在PubMed和Embase中搜索了相关文章，并根据在最初搜索中检索到的文章中的引文检索了其他文章。2名独立审阅者使用质量研究质量评估工具对质量进行了评估，并且通过讨论和相互同意对质量分数进行了调和。

发现 8项研究符合纳入标准，其中3项为干预前和干预后比较研究，3项为对照临床研究，1项为时间序列研究，1项将干预后结果与预定基线进行比较。在组织级别进行的干预（包括对电子健康记录订单集和工作流程的更改）显示出明显的积极结果。此外，有2项研究以根据患者实际使用阿片类药物的使用为基础制定指南并将这些指南传播给临床医生为中心，报告减少了处方量达53％。在评估这些结果的研究中，没有报告急诊就诊或补充需求的增加。然而，

结论与相关性 所审查的研究提供了证据，证明临床医生介导的和组织级的干预措施是在手术后类阿片处方中产生变化的有力工具。本摘要强调了缺乏高质量的研究，这些研究没有提供关于减少术后阿片类药物处方的最有效干预措施的明确证据。