{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T12:05:47Z","timestamp":1790251547673,"version":"4.1.0"},"reference-count":20,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T00:00:00Z","timestamp":1786924800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T00:00:00Z","timestamp":1786924800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["ANZ Journal of Surgery"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Emergency general surgery (EGS) is associated with high postoperative pain burden and historically relies on opioid\u2010centric analgesia, which can delay recovery and increase opioid\u2010related adverse events and longer\u2010term exposure. Evidence for scalable, system\u2010level opioid\u2010sparing pathways in pragmatic emergency surgical settings remains limited, particularly in Asian tertiary health systems.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a pragmatic, multicentre and cluster\u2010randomised stepped\u2010wedge trial in 12 Chinese tertiary hospitals comparing usual care with a structured multimodal opioid\u2010sparing perioperative analgesia pathway. The primary outcome was cumulative 48\u2010h postoperative opioid consumption (oral morphine milligram equivalents, MME). Secondary outcomes assessed pain, recovery, safety and post\u2010discharge opioid exposure. Mixed\u2010effects models accounted for clustering and period effects.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 3646 enrolled patients, primary outcome data were available for 3561 (97.7%). Mean 48\u2010h opioid consumption decreased from 64.2 to 46.1\u2009MME, with an adjusted reduction of \u221218.1\u2009MME (95% CI\u2009=\u2009\u221221.4 to \u221214.7;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and a ratio of means of 0.76 (95% CI\u2009=\u20090.72\u20130.80;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). High opioid exposure (&gt;\u2009100\u2009MME) declined (17.2% vs. 9.9%; OR\u2009=\u20090.52), while opioid\u2010free status at 48\u2009h increased (8.0% vs. 17.7%; OR\u2009=\u20092.47) (both\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Pain burden, recovery metrics, opioid\u2010related adverse events and persistent opioid use at 30\u2009days all favoured the intervention.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A structured opioid\u2010sparing pathway reduced early postoperative opioid exposure and improved recovery and safety outcomes in EGS, supporting wider implementation of multimodal opioid stewardship.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ans.70888","type":"journal-article","created":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:53:06Z","timestamp":1787017986000},"page":"2608-2614","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Multicentre Cluster Randomised Stepped Wedge Trial of Opioid Sparing Analgesia in Emergency General Surgery"],"prefix":"10.1111","volume":"96","author":[{"given":"Chao","family":"Ren","sequence":"first","affiliation":[{"name":"Department of Pharmacy Tangdu Hospital, Fourth Military Medical University  Xi'an China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-4869-2276","authenticated-orcid":false,"given":"Shicao","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Tangdu Hospital, Fourth Military Medical University  Xi'an China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tian","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Tangdu Hospital, Fourth Military Medical University  Xi'an China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Ding","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Taixing People's Hospital Affiliated to Yangzhou University  Taixing China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,17]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-022-06763-y"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjoq-2020-001320"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/j.pain.0000000000003529"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.3390\/pharmacy12020062"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1037\/hea0001477"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs-2020-012337"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40122-022-00393-x"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000007619"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12871-019-0804-9"},{"key":"e_1_2_10_11_1","first-page":"1","article-title":"Increasing System\u2010Wide Implementation of Opioid Prescribing Guidelines in Primary Care: Findings From a Non\u2010Randomized Stepped\u2010Wedge Quality Improvement Project","volume":"21","author":"Zgierska A. E.","year":"2020","journal-title":"BMC Primary Care"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13063-020-04851-9"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13017-022-00455-7"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11916-017-0607-y"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2021.03.028"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13017-023-00519-2"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13063-023-07807-x"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.3390\/medicina54020020"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cct.2020.106250"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.5070\/M57358080"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2024.02.024"}],"container-title":["ANZ Journal of Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ans.70888","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/ans.70888","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ans.70888","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T11:15:29Z","timestamp":1790248529000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ans.70888"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,17]]},"references-count":20,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1111\/ans.70888"],"URL":"https:\/\/doi.org\/10.1111\/ans.70888","archive":["Portico"],"relation":{},"ISSN":["1445-1433","1445-2197"],"issn-type":[{"value":"1445-1433","type":"print"},{"value":"1445-2197","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,17]]},"assertion":[{"value":"2026-05-20","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-20","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-17","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}