Introduction: Patients undergoing oncologic surgery are at risk for persistent postoperative opioid use. As a quality improvement initiative, we 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: Pre-education response rates were 72/103 (70%): 22/34 (65%) attendings, 19/21 (90%) fellows, 31/48 (65%) APPs. For 5 index operations (open abdominal resection, laparoscopic colectomy, wide local excision, thyroidectomy, port), fellows answered that patients should be off opioids sooner than attendings/APPs. For 4/5 procedures, APPs recommended higher discharge opioid prescriptions than attendings/fellows. Forty-six providers (45%) responded to both pre-and post-education surveys. After the intervention, providers recommended lower numbers of opioid pills and indicated that patients should be off opioids sooner for all procedures. Compared to preeducation, more providers agreed that discharge opioid prescriptions should be based on a patient's last 24 hours of inpatient opioid use (83% vs. 91%, p=0.006). Providers who did not attend a session showed no difference in perceptions or recommendations on 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 felt patients should be off opioids sooner. Next steps include assessing for quantitative changes in opioid prescribing and implementing standardized opioid prescription algorithms.

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Implementation of risk-stratified pancreatectomy clinical pathways decreased median stay and cost of index hospitalization after pancreatectomy without unfavorably affecting rates of perioperative adverse events or readmission, or discharge disposition. Outcomes were most favorably improved for low-risk pancreatoduodenectomy and distal pancreatectomy. Additional work is necessary to decrease the rate of postoperative pancreatic fistula, minimize variability, and improve outcomes after high-risk pancreatoduodenectomy.

Background and Objectives A department‐wide opioid reduction education program resulted in a 1‐month change in perceptions of opioid needs and prescribing recommendations for surgical oncology patients. This study's aim was to re‐evaluate if early trends were retained 1 year later. Methods Surgical Oncology attendings, fellows, and advanced practice providers at a Comprehensive Cancer Center were surveyed 1‐year after an August 2018 opioid reduction education program, to compare departmental and individual opioid prescribing habits. Results The September 2019 response rate was 54/93 (58%), with 41 completing both the post‐education and 1‐year follow‐up surveys. The departmental and matched cohort continued to recommend a lower quantity of discharge opioids for all five index operations (by >50%) and expected less postoperative days to zero opioid needs, when compared to pre‐education perceptions. Providers continued to agree that discharge opioid prescriptions should be based on a patient's last 24 hours of inpatient opioid use. There was universal agreement that each respondent's opioid administration had decreased in the past year. Conclusions The initial 1‐month improvements in perioperative opioid prescribing perceptions were retained 1 year later by Surgical Oncology providers who recommended fewer discharge opioids, faster weaning to zero opioids, and standardized patient‐specific discharge opioid volume calculations.

Objective: To characterize opioid discharge prescriptions for pancreatectomy patients. Background: Wide variation in and over-prescription of opioids after surgery contribute to the United States opioid epidemic through persistent use past the postoperative period. Objective strategies guiding discharge opioid prescriptions for oncologic surgery are lacking, and factors driving prescription amount are not fully delineated. Methods: Characteristics of pancreatectomy patients (March 2016–August 2017) were retrospectively abstracted from a prospective database. Discharge opioids prescriptions were converted to oral morphine equivalents (OME). Regression models identified variables associated with discharge OME. Results: In 158 consecutive patients, median discharge OME was 250 mg (range 0–3950). Discharge OME was labeled “low” (<200 mg) for 33 patients (21%) and “high” (>400 mg) for 38 (24%). Only shorter operative time (odds ratio [OR]—0.14, P = 0.004) and inpatient team (OR—15.39, P < 0.001) were independently associated with low discharge OME. Older age was the only variable associated with high discharge OME. Fifty-seven patients (36%) used zero opioids in the last 24-hours predischarge, yet 52 of 57 (91%) still received discharge opioids. Older age (OR—1.07), grade B/C pancreatic fistula (OR—3.84), and epidural use (OR—3.12) were independently associated with zero last-24-hours OME (all P ≤ 0.040). Conclusions: The wide variation in discharge opioid prescriptions is heavily influenced by provider routine/bias and not by objective criteria such as last-24-hours OME. Quality improvement strategies could include aggressive weaning protocols to increase the proportion of patients with zero/near-zero last-24-hour OME and limiting prescriptions to a conservative multiplier of the last-24-hour OME.

State-specific limits on total days and procedure-specific recommendations of discharge opioid volumes have had mixed success in mitigating postoperative opioid dissemination. 1,2 Most prescribers still expose their clinician-specific bias in writing round numbers of opioid doses (eg, 30-50 pills). In the theme of patient-centered care, this study analyzed oncologic surgery discharge opioid prescriptions and 30-day refills when a novel, patient-centered prescription calculation was implemented.

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