Abstract:
BACKGROUND:Patients undergoing oncologic surgery are at risk for persistent postoperative opioid use. As a quality improvement initiative, this study sought to characterize provider perceptions regarding opioid-prescribing after oncologic procedures. METHODS:Surgical oncology attending physicians, clinical fellows, and advanced practice providers (APPs) at a high-volume cancer center were surveyed before and after educational sessions focusing on the opioid epidemic with review of departmental data. RESULTS:The pre-education response rates were 72 (70%) of 103: 22 (65%) of 34 attending physicians, 19 (90%) of 21 fellows, and 31 (65%) of 48 APPs. For five index operations (open abdominal resection, laparoscopic colectomy, wide local excision, thyroidectomy, port), the fellows answered that patients should stop receiving opioids sooner than recommended by the attending surgeons or APPs. For four of five procedures, the APPs recommended higher discharge opioid prescriptions than the attending surgeons or fellows. Almost half of the providers (n = 46, 45%) responded to both the pre- and post-education surveys. After the intervention, the providers recommended lower numbers of opioid pills and indicated that patients should be weaned from opioids sooner for all the procedures. Compared with pre-education, more providers agreed post-education that discharge opioid prescriptions should be based on a patient's last 24 h of inpatient opioid use (83 vs 91%; p = 0.006). The providers who did not attend a session showed no difference in perceptions or recommendations at the repeat assessment. CONCLUSIONS:Variation exists in perioperative opioid-prescribing among provider types, with those most involved in daily care and discharge processes generally recommending more opioids. After education, providers lowered discharge opioid recommendations and thought patients should stop receiving opioids sooner. The next steps include assessing for quantitative changes in opioid-prescribing and implementing standardized opioid prescription algorithms.
journal_name
Ann Surg Oncoljournal_title
Annals of surgical oncologyauthors
Lillemoe HA,Newhook TE,Vreeland TJ,Arvide EM,Dewhurst WL,Grubbs EG,Aloia TA,Vauthey JN,Lee JE,Tzeng CDdoi
10.1245/s10434-019-07321-ysubject
Has Abstractpub_date
2019-07-01 00:00:00pages
2011-2018issue
7eissn
1068-9265issn
1534-4681pii
10.1245/s10434-019-07321-yjournal_volume
26pub_type
杂志文章abstract:BACKGROUND:Examination of pathology slides is a routine part of a breast cancer second opinion. The purpose of this study was to determine how often the pathologic second opinion (1) altered the diagnosis and (2) resulted in a change in the surgical procedure. METHODS:Patients presenting between 1997 and 2001 for a se...
journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1007/BF02574516
更新日期:2002-12-01 00:00:00
abstract:BACKGROUND/AIM:Perioperative administration of immunoenriched diets attenuates the perioperative inflammatory response and reduces postoperative infection complications. However, many questions still remain unresolved in this area, such as the length of diet administration, diet composition, and the mechanisms involved...
journal_title:Annals of surgical oncology
pub_type: 杂志文章,随机对照试验
doi:10.1245/s10434-007-9407-7
更新日期:2007-10-01 00:00:00
abstract:BACKGROUND:Cysteine/histidine-rich 1 (CYHR1) was first discovered in a yeast two-hybrid screen with murine galectin-3, and no previous reports have described a relationship between the CYHR1 gene and human cancer. The current study evaluated the role and significance of CYHR1 in esophageal cancer. METHODS:The human es...
journal_title:Annals of surgical oncology
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doi:10.1245/s10434-015-5031-0
更新日期:2017-02-01 00:00:00
abstract:BACKGROUND:CD8+ T cell-eliciting vaccines are being investigated in breast cancer patients. Preclinical data showed that trastuzumab increases the susceptibility of tumor cells to lysis by vaccine-generated CD8+ T cells, suggesting potential benefit of a combination immunotherapy strategy. The current trial was underta...
journal_title:Annals of surgical oncology
pub_type: 杂志文章
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更新日期:2017-08-01 00:00:00
abstract:BACKGROUND:Laparoscopic rectal cancer surgery aims to provide patients with curative resection while minimizing postoperative morbidity and mortality. This study used meta-analytical techniques to compare laparoscopic and open surgery as the primary treatment for patients with rectal cancer with regard to short-term an...
journal_title:Annals of surgical oncology
pub_type: 杂志文章,meta分析
doi:10.1245/ASO.2006.05.045
更新日期:2006-03-01 00:00:00
abstract:BACKGROUND:Pancreatic adenocarcinoma impinging the portal and/or superior mesenteric vein (PV-SMV) is classified as borderline resectable, and preoperative chemoradiation is recommended to increase the margin-negative resection rate. There is no consensus about what degree of venous impingement constitutes borderline r...
journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1245/s10434-010-1284-9
更新日期:2010-11-01 00:00:00
abstract:BACKGROUND:The decision to receive adjuvant chemotherapy is far from evident and remains controversial in patients with American Joint Committee on Cancer stage II colon cancer. This study analyzes several pathological characteristics in order to assess their (combined) predictive value for outcomes in stage II colon c...
journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1245/s10434-016-5387-9
更新日期:2016-11-01 00:00:00
abstract:INTRODUCTION:Lymphadenectomy and thyroidectomy is standard treatment for medullary thyroid carcinoma (MTC), but the prognostic importance of the number of lymph nodes removed (lymph node yield, LNY) and the proportion of metastatic lymph nodes resected (metastatic lymph node ratio, MLNR) is unknown. We hypothesized tha...
journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1245/s10434-008-0022-z
更新日期:2008-09-01 00:00:00
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journal_title:Annals of surgical oncology
pub_type: 杂志文章,评审
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journal_title:Annals of surgical oncology
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更新日期:2017-06-01 00:00:00
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journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1245/s10434-008-9839-8
更新日期:2008-06-01 00:00:00
abstract:: ...
journal_title:Annals of surgical oncology
pub_type: 社论
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abstract:BACKGROUND:Small bowel adenocarcinoma is a relatively rare cancer, often diagnosed in an advanced stage. In localized and resectable disease, surgery alone or in combination with adjuvant chemotherapy is the mainstay of treatment. In the recently published National Comprehensive Cancer Network Clinical Practice guideli...
journal_title:Annals of surgical oncology
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更新日期:2021-02-01 00:00:00
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journal_title:Annals of surgical oncology
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更新日期:2012-12-01 00:00:00
abstract:BACKGROUND:Hepatic resection is potentially curative in selected patients with colorectal metastases. It is a widely held practice that multiple colorectal hepatic metastases are not resected, although outcome after removal of four or more metastases is not well defined. METHODS:Patients with four or more colorectal h...
journal_title:Annals of surgical oncology
pub_type: 杂志文章
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更新日期:2000-10-01 00:00:00
abstract:BACKGROUND:Surgery is the most important treatment for nonmetastatic breast cancer; however, the utilization of modern surgical techniques in management of breast cancer in mainland China has not been reported. METHODS:The medical records of 5887 consecutive breast cancer patients treated surgically in the past 16 yea...
journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1245/s10434-007-9436-2
更新日期:2007-09-01 00:00:00
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journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1245/s10434-019-07274-2
更新日期:2019-11-01 00:00:00
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journal_title:Annals of surgical oncology
pub_type: 杂志文章
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更新日期:2011-12-01 00:00:00
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journal_title:Annals of surgical oncology
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pub_type: 杂志文章
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journal_title:Annals of surgical oncology
pub_type: 杂志文章
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更新日期:2013-04-01 00:00:00
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journal_title:Annals of surgical oncology
pub_type: 杂志文章
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更新日期:2013-09-01 00:00:00
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journal_title:Annals of surgical oncology
pub_type: 杂志文章,多中心研究
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更新日期:2009-01-01 00:00:00
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journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1007/BF02306280
更新日期:1996-05-01 00:00:00
abstract:BACKGROUND:Cancer patients have often been reported to have impaired immune function, and the effect of treatment modalities, such as surgery, irradiation, and chemotherapy, in depressing patients' immunity has also been reported. In this investigation, the effect of treatment on the cellular immunity of esophageal can...
journal_title:Annals of surgical oncology
pub_type: 杂志文章
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abstract:BACKGROUND:Complete ablation rates after a single session of radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC) vary from 48% to 97%. Limited data are available regarding risk factors and prognostic significance of incomplete ablation. METHODS:Between April 2001 and March 2006, 298 patients underwent RFA ...
journal_title:Annals of surgical oncology
pub_type: 杂志文章
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更新日期:2008-03-01 00:00:00
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pub_type: 杂志文章,多中心研究
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abstract:: ...
journal_title:Annals of surgical oncology
pub_type: 评论,杂志文章
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更新日期:2018-12-01 00:00:00