{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T02:46:04Z","timestamp":1791081964002,"version":"4.1.0"},"reference-count":53,"publisher":"American Medical Association (AMA)","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Surg"],"abstract":"\n Importance<\/jats:title>\n Postoperative opioid overprescribing leads to persistent opioid use and excess pills at risk for misuse and diversion. A learning health system paradigm using risk-stratified pancreatectomy clinical pathways (RSPCPs) may lead to reduction in inpatient and discharge opioid volume.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To analyze the outcomes of 2 iterative RSPCP updates on inpatient and discharge opioid volumes.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This cohort study included 832 consecutive adult patients at an urban comprehensive cancer center who underwent pancreatic resection between October 2016 and April 2022, comprising 3 sequential pathway cohorts (version [V] 1, October 1, 2016, to January 31, 2019 [n\u2009=\u2009363]; V2, February 1, 2019, to October 31, 2020 [n\u2009=\u2009229]; V3, November 1, 2020, to April 30, 2022 [n\u2009=\u2009240]).<\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n After V1 of the pathway established a baseline and reduced length of stay (n\u2009=\u2009363), V2 (n\u2009=\u2009229) updated patient and surgeon education handouts, limited intravenous opioids, suggested a 3-drug (acetaminophen, celecoxib, methocarbamol) nonopioid bundle, and implemented the 5\u00d7-multiplier (last 24-hour oral morphine equivalents [OME] multiplied by 5) to calculate discharge volume. Pathway version 3 (n\u2009=\u2009240) required the nonopioid bundle as default in the recovery room and scheduled conversion to oral medications on postoperative day 1.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Inpatient and discharge opioid volume in OME across the 3 RSPCPs were compared using nonparametric testing and trend analyses.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 832 consecutive patients (median [IQR] age, 65 [56-72] years; 410 female [49.3%] and 422 male [50.7%]) underwent 541 pancreatoduodenectomies, 285 distal pancreatectomies, and 6 other pancreatectomies. Early nonopioid bundle administration increased from V1 (acetaminophen, 320 patients [88.2%]; celecoxib or anti-inflammatory, 98 patients [27.0%]; methocarbamol, 267 patients [73.6%]) to V3 (236 patients [98.3%], 163 patients [67.9%], and 238 patients [99.2%], respectively;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001). Total inpatient OME decreased from a median 290 mg (IQR, 157-468 mg) in V1 to 184 mg (IQR, 103-311 mg) in V2 to 129 mg (IQR, 75-206 mg) in V3 (\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001). Discharge OME decreased from a median 150 mg (IQR, 100-225 mg) in V1 to 25 mg (IQR, 0-100 mg) in V2 to 0 mg (IQR, 0-50 mg) in V3 (\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001). The percentage of patients discharged opioid free increased from 7.2% (26 of 363) in V1 to 52.5% (126 of 240) in V3 (\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001), with 187 of 240 (77.9%) in V3 discharged with 50 mg OME or less. Median pain scores remained 3 or lower in all cohorts, with no differences in postdischarge refill requests. A subgroup analysis separating open and minimally invasive surgical cases showed similar results in both groups.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this cohort study, the median total inpatient OME was halved and median discharge OME reduced to zero in association with a learning health system model of iterative opioid reduction that is freely adaptable by other hospitals. These findings suggest that opioid-free discharge after pancreatectomy and other major cancer operations is realistic and feasible with this no-cost blueprint.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamasurg.2023.4154","type":"journal-article","created":{"date-parts":[[2023,9,6]],"date-time":"2023-09-06T11:02:42Z","timestamp":1693998162000},"page":"e234154","source":"Crossref","is-referenced-by-count":18,"title":["Opioid-Free Discharge After Pancreatic Resection Through a Learning Health System Paradigm"],"prefix":"10.1001","volume":"158","author":[{"given":"Artem","family":"Boyev","sequence":"first","affiliation":[{"name":"Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anish J.","family":"Jain","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy E.","family":"Newhook","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura R.","family":"Prakash","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi-Ju","family":"Chiang","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Morgan L.","family":"Bruno","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elsa M.","family":"Arvide","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Whitney L.","family":"Dewhurst","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael P.","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica E.","family":"Maxwell","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naruhiko","family":"Ikoma","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca A.","family":"Snyder","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey E.","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew H. G.","family":"Katz","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ching-Wei D.","family":"Tzeng","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2023,11,8]]},"reference":[{"issue":"1","key":"soi230060r1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1097\/FTD.0000000000000817","article-title":"The North American opioid epidemic.","volume":"43","author":"Jannetto","year":"2021","journal-title":"Ther Drug Monit"},{"issue":"3","key":"soi230060r3","doi-asserted-by":"publisher","first-page":"409","DOI":"10.1016\/j.amepre.2015.02.020","article-title":"Trends in opioid analgesic-prescribing rates by specialty, U.S., 2007-2012.","volume":"49","author":"Levy","year":"2015","journal-title":"Am J Prev Med"},{"issue":"36","key":"soi230060r4","doi-asserted-by":"publisher","first-page":"4042","DOI":"10.1200\/JCO.2017.74.1363","article-title":"New persistent opioid use among patients with cancer after curative-intent surgery.","volume":"35","author":"Lee","year":"2017","journal-title":"J Clin Oncol"},{"issue":"11","key":"soi230060r5","doi-asserted-by":"publisher","first-page":"1611","DOI":"10.1001\/jamaoncol.2018.4387","article-title":"Opioid use after open resection or video-assisted thoracoscopic surgery for early-stage lung cancer.","volume":"4","author":"Tuminello","year":"2018","journal-title":"JAMA Oncol"},{"issue":"6","key":"soi230060r6","doi-asserted-by":"publisher","first-page":"1004","DOI":"10.1016\/j.jamcollsurg.2018.01.058","article-title":"Post-discharge opioid prescribing and use after common surgical procedure.","volume":"226","author":"Fujii","year":"2018","journal-title":"J Am Coll Surg"},{"issue":"3","key":"soi230060r7","doi-asserted-by":"publisher","first-page":"457","DOI":"10.1097\/SLA.0000000000002919","article-title":"Results of a prospective, multicenter initiative aimed at developing opioid-prescribing guidelines after surgery.","volume":"268","author":"Thiels","year":"2018","journal-title":"Ann Surg"},{"key":"soi230060r8","doi-asserted-by":"publisher","first-page":"208","DOI":"10.1016\/j.jss.2022.01.030","article-title":"Surgery prescription opioid misuse and diversion in US adults and associated risk factors.","volume":"275","author":"Porter","year":"2022","journal-title":"J Surg Res"},{"key":"soi230060r10","doi-asserted-by":"publisher","first-page":"749","DOI":"10.1245\/s10434-019-07876-w","article-title":"ASO author reflections: opportunities for reducing initial opioid exposure in cancer surgery patients.","volume":"26","author":"Newhook","year":"2019","journal-title":"Ann Surg Oncol"},{"issue":"2","key":"soi230060r11","doi-asserted-by":"publisher","first-page":"e9","DOI":"10.1097\/SLA.0000000000003595","article-title":"Opioid-prescribing practices after oncologic surgery: opportunities for improvement and a call to action.","volume":"271","author":"Newhook","year":"2020","journal-title":"Ann Surg"},{"issue":"3","key":"soi230060r12","doi-asserted-by":"publisher","first-page":"547","DOI":"10.1002\/jso.v122.3","article-title":"Educating surgical oncology providers on perioperative opioid use: a departmental survey 1 year after the intervention.","volume":"122","author":"Kim","year":"2020","journal-title":"J Surg Oncol"},{"issue":"7","key":"soi230060r13","doi-asserted-by":"publisher","first-page":"2011","DOI":"10.1245\/s10434-019-07321-y","article-title":"Educating surgical oncology providers on perioperative opioid use: results of a departmental survey on perceptions of opioid needs and prescribing habits.","volume":"26","author":"Lillemoe","year":"2019","journal-title":"Ann Surg Oncol"},{"key":"soi230060r14","doi-asserted-by":"publisher","first-page":"731","DOI":"10.1245\/s10434-019-07837-3","article-title":"ASO author reflections: opioid prescribing in surgical oncology\u2014institutional opportunities for educational interventions.","volume":"26","author":"Lillemoe","year":"2019","journal-title":"Ann Surg Oncol"},{"issue":"11","key":"soi230060r15","doi-asserted-by":"publisher","first-page":"3428","DOI":"10.1245\/s10434-019-07528-z","article-title":"Inpatient opioid use after pancreatectomy: opportunities for reducing initial opioid exposure in cancer surgery patients.","volume":"26","author":"Newhook","year":"2019","journal-title":"Ann Surg Oncol"},{"issue":"1","key":"soi230060r16","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1097\/SLA.0000000000003112","article-title":"Clinical factors associated with practice variation in discharge opioid prescriptions after pancreatectomy.","volume":"272","author":"Newhook","year":"2020","journal-title":"Ann Surg"},{"issue":"11","key":"soi230060r18","doi-asserted-by":"publisher","first-page":"1109","DOI":"10.1001\/jama.2014.705","article-title":"Transforming from centers of learning to learning health systems: the challenge for academic health centers.","volume":"311","author":"Grumbach","year":"2014","journal-title":"JAMA"},{"issue":"1","key":"soi230060r19","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1002\/jso.v124.1","article-title":"Sustained reduction in discharge opioid volumes through provider education: results of 1168 cancer surgery patients over 2 years.","volume":"124","author":"Kim","year":"2021","journal-title":"J Surg Oncol"},{"issue":"3","key":"soi230060r20","doi-asserted-by":"publisher","first-page":"424","DOI":"10.1016\/j.surg.2018.04.014","article-title":"Risk-stratified clinical pathways decrease the duration of hospitalization and costs of perioperative care after pancreatectomy.","volume":"164","author":"Denbo","year":"2018","journal-title":"Surgery"},{"key":"soi230060r21","doi-asserted-by":"publisher","first-page":"244","DOI":"10.1016\/j.jss.2022.02.031","article-title":"Association of patient controlled analgesia and total inpatient opioid use after pancreatectomy.","volume":"275","author":"Witt","year":"2022","journal-title":"J Surg Res"},{"issue":"12","key":"soi230060r22","doi-asserted-by":"publisher","first-page":"1166","DOI":"10.1001\/jamasurg.2020.3527","article-title":"Assessing the 5\u00d7-multiplier calculation to reduce discharge opioid prescription volumes after inpatient surgery.","volume":"155","author":"Day","year":"2020","journal-title":"JAMA Surg"},{"key":"soi230060r23","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1016\/j.sopen.2022.04.004","article-title":"A prospective feasibility study evaluating the 5x-multiplier to standardize discharge prescriptions in cancer surgery patients.","volume":"9","author":"DiPeri","year":"2022","journal-title":"Surg Open Sci"},{"issue":"5","key":"soi230060r24","doi-asserted-by":"publisher","first-page":"1054","DOI":"10.1007\/s11605-021-05235-3","article-title":"Iterative changes in risk-stratified pancreatectomy clinical pathways and accelerated discharge after pancreaticoduodenectomy.","volume":"26","author":"Newton","year":"2022","journal-title":"J Gastrointest Surg"},{"issue":"1","key":"soi230060r26","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1097\/XCS.0000000000000652","article-title":"Differential gains in surgical outcomes for high-risk vs low-risk pancreaticoduodenectomy with successive refinements of risk-stratified care pathways.","volume":"237","author":"Ayabe","year":"2023","journal-title":"J Am Coll Surg"},{"issue":"4","key":"soi230060r27","doi-asserted-by":"publisher","first-page":"523","DOI":"10.1002\/jhbp.v30.4","article-title":"Comparative analysis of opioid use between robotic and open pancreatoduodenectomy.","volume":"30","author":"Witt","year":"2023","journal-title":"J Hepatobiliary Pancreat Sci"},{"issue":"9","key":"soi230060r28","doi-asserted-by":"publisher","first-page":"5861","DOI":"10.1245\/s10434-022-11836-2","article-title":"Analysis of opioid use in patients undergoing open versus robotic gastrectomy.","volume":"29","author":"Hirata","year":"2022","journal-title":"Ann Surg Oncol"},{"issue":"2","key":"soi230060r29","doi-asserted-by":"publisher","first-page":"177","DOI":"10.1097\/SLA.0b013e3181afde41","article-title":"The Accordion severity grading system of surgical complications.","volume":"250","author":"Strasberg","year":"2009","journal-title":"Ann Surg"},{"issue":"2","key":"soi230060r31","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1345\/aph.1H421","article-title":"Opioid conversions in acute care.","volume":"41","author":"Patanwala","year":"2007","journal-title":"Ann Pharmacother"},{"issue":"5","key":"soi230060r32","doi-asserted-by":"publisher","first-page":"397","DOI":"10.1016\/S0885-3924(01)00271-8","article-title":"Accuracy in equianalgesic dosing: conversion dilemmas.","volume":"21","author":"Anderson","year":"2001","journal-title":"J Pain Symptom Manage"},{"issue":"2","key":"soi230060r33","doi-asserted-by":"publisher","first-page":"672","DOI":"10.1016\/S0885-3924(01)00294-9","article-title":"Equianalgesic dose ratios for opioids: a critical review and proposals for long-term dosing.","volume":"22","author":"Pereira","year":"2001","journal-title":"J Pain Symptom Manage"},{"issue":"6","key":"soi230060r34","doi-asserted-by":"publisher","first-page":"1066","DOI":"10.1002\/jso.v122.6","article-title":"Perceptions of opioid use and prescribing habits in oncologic surgery: a survey of the society of surgical oncology membership.","volume":"122","author":"Lillemoe","year":"2020","journal-title":"J Surg Oncol"},{"issue":"3","key":"soi230060r35","doi-asserted-by":"publisher","first-page":"655","DOI":"10.1016\/j.surg.2020.09.013","article-title":"Preoperative patient opioid education, standardization of prescriptions, and their impact on overall patient satisfaction.","volume":"169","author":"Elhage","year":"2021","journal-title":"Surgery"},{"issue":"5","key":"soi230060r36","doi-asserted-by":"publisher","first-page":"852","DOI":"10.1016\/j.surg.2020.01.002","article-title":"Preoperative patient education and patient preparedness are associated with less postoperative use of opioids.","volume":"167","author":"Khorfan","year":"2020","journal-title":"Surgery"},{"issue":"4","key":"soi230060r37","doi-asserted-by":"publisher","first-page":"719","DOI":"10.1002\/jso.v125.4","article-title":"Utilization and evolving prescribing practice of opioid and non-opioid analgesics in patients undergoing lymphadenectomy for cutaneous malignancy.","volume":"125","author":"Witt","year":"2022","journal-title":"J Surg Oncol"},{"key":"soi230060r38","doi-asserted-by":"publisher","first-page":"399","DOI":"10.1016\/j.jss.2020.08.012","article-title":"An educational intervention reduces opioids prescribed following general surgery procedures.","volume":"257","author":"Kemp Bohan","year":"2021","journal-title":"J Surg Res"},{"issue":"3","key":"soi230060r39","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1097\/AJP.0000000000000792","article-title":"Enhanced recovery after surgery (ERAS): a perspective review of postoperative pain management under ERAS pathways and its role on opioid crisis in the United States.","volume":"36","author":"Echeverria-Villalobos","year":"2020","journal-title":"Clin J Pain"},{"issue":"5","key":"soi230060r40","doi-asserted-by":"publisher","first-page":"583","DOI":"10.1002\/jso.v116.5","article-title":"Enhanced recovery after surgery: pain management.","volume":"116","author":"Nimmo","year":"2017","journal-title":"J Surg Oncol"},{"issue":"3","key":"soi230060r41","doi-asserted-by":"publisher","first-page":"241","DOI":"10.1016\/j.jamcollsurg.2020.12.014","article-title":"Multi-modal analgesic strategy for trauma: a pragmatic randomized clinical trial.","volume":"232","author":"Harvin","year":"2021","journal-title":"J Am Coll Surg"},{"issue":"6","key":"soi230060r42","doi-asserted-by":"publisher","first-page":"1122","DOI":"10.1016\/j.amjsurg.2019.09.032","article-title":"Implementation of a multi-modal pain regimen to decrease inpatient opioid exposure after injury.","volume":"218","author":"Wei","year":"2019","journal-title":"Am J Surg"},{"key":"soi230060r43","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1016\/j.jss.2022.04.032","article-title":"Less is more: a multimodal pain management strategy is associated with reduced opioid use in hospitalized trauma patients.","volume":"278","author":"Kay","year":"2022","journal-title":"J Surg Res"},{"issue":"6","key":"soi230060r44","doi-asserted-by":"publisher","first-page":"1146","DOI":"10.1093\/jbcr\/irab143","article-title":"Impact of opioid-minimizing pain protocols after burn injury.","volume":"42","author":"Donthula","year":"2021","journal-title":"J Burn Care Res"},{"issue":"4","key":"soi230060r45","doi-asserted-by":"publisher","first-page":"378","DOI":"10.1001\/jamasurg.2022.7652","article-title":"Implementation and assessment of no opioid prescription strategy at discharge after major urologic cancer surgery.","volume":"158","author":"Mian","year":"2023","journal-title":"JAMA Surg"},{"issue":"1","key":"soi230060r46","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1097\/XCS.0000000000000231","article-title":"Prospective implementation of standardized post-hepatectomy care pathways to reduce opioid prescription volume after inpatient surgery.","volume":"235","author":"DiPeri","year":"2022","journal-title":"J Am Coll Surg"},{"issue":"10343","key":"soi230060r47","doi-asserted-by":"publisher","first-page":"2280","DOI":"10.1016\/S0140-6736(22)00582-7","article-title":"Opioid versus opioid-free analgesia after surgical discharge: a systematic review and meta-analysis of randomised trials.","volume":"399","author":"Fiore","year":"2022","journal-title":"Lancet"},{"issue":"2","key":"soi230060r48","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2017.4859","article-title":"Correlation between 24-hour predischarge opioid use and amount of opioids prescribed at hospital discharge.","volume":"153","author":"Chen","year":"2018","journal-title":"JAMA Surg"},{"issue":"3","key":"soi230060r50","doi-asserted-by":"publisher","first-page":"285","DOI":"10.1001\/jamasurg.2017.4436","article-title":"Reduction in opioid prescribing through evidence-based prescribing guidelines.","volume":"153","author":"Howard","year":"2018","journal-title":"JAMA Surg"},{"issue":"6","key":"soi230060r51","doi-asserted-by":"publisher","first-page":"823","DOI":"10.1016\/j.jamcollsurg.2020.12.057","article-title":"Guidelines for patient-centered opioid prescribing and optimal FDA-compliant disposal of excess pills after inpatient operation: prospective clinical trial.","volume":"232","author":"Porter","year":"2021","journal-title":"J Am Coll Surg"},{"key":"soi230060r52","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1016\/j.jss.2022.04.057","article-title":"Opioid discharge prescriptions after inpatient surgery: risks of rebound refills by length of stay.","volume":"278","author":"DiPeri","year":"2022","journal-title":"J Surg Res"},{"issue":"4","key":"soi230060r53","doi-asserted-by":"publisher","first-page":"558","DOI":"10.1016\/j.hpb.2021.09.006","article-title":"Pain management, fluid therapy and thromboprophylaxis after pancreatoduodenectomy: a worldwide survey among surgeons.","volume":"24","author":"Groen","year":"2022","journal-title":"HPB (Oxford)"},{"key":"soi230060r2","unstructured":"CDC WONDER. Centers for Disease Control and Prevention, National Center for Health Statistics. Accessed October 18, 2022. https:\/\/wonder.cdc.gov\/"},{"key":"soi230060r9","unstructured":"Key substance use and mental health indicators in the United States: results from the 2019 National Survey on Drug Use and Health. Substance Abuse and Mental Health Services Administration. Accessed October 18, 2022. https:\/\/store.samhsa.gov\/product\/key-substance-use-and-mental-health-indicators-in-the-united-states-results-from-the-2019-national-survey-on-Drug-Use-and-Health\/PEP20-07-01-001"},{"key":"soi230060r17","unstructured":"About Learning Health Systems. Agency for Healthcare Research and Quality. Accessed May 22, 2022. https:\/\/www.ahrq.gov\/learning-health-systems\/about.html"},{"key":"soi230060r25","unstructured":"Repeat quadratus lumborum block to reduce opioid need in patients after pancreatic surgery. ClinicalTrials.gov identifier: NCT03745794. Updated February 2, 2013. Accessed May 30, 2023. https:\/\/clinicaltrials.gov\/study\/NCT03745794?term=NCT03745794&rank=1"},{"key":"soi230060r30","unstructured":"Cancer pain\u2013adult. The University of Texas MD Anderson Cancer Center; 2020. Accessed October 18, 2022. https:\/\/www.mdanderson.org\/content\/dam\/mdanderson\/documents\/for-physicians\/algorithms\/clinical-management\/clin-management-cancer-pain-web-algorithm.pdf"},{"key":"soi230060r49","unstructured":"Adult prescribing recommendations. Michigan OPEN; 2022. Accessed October 18, 2022. https:\/\/michigan-open.org\/wp-content\/uploads\/2022\/02\/All-Adult-Prescribing-Recs.pdf.pdf"}],"container-title":["JAMA Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamasurgery\/articlepdf\/2809262\/jamasurgery_boyev_2023_oi_230060_1699372320.8594.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,8]],"date-time":"2023-11-08T11:06:29Z","timestamp":1699441589000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamasurgery\/fullarticle\/2809262"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11,8]]},"references-count":53,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2023,11,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamasurg.2023.4154","relation":{},"ISSN":["2168-6254"],"issn-type":[{"value":"2168-6254","type":"print"}],"subject":[],"published":{"date-parts":[[2023,11,8]]}}}