Assessing the impact of procedure-specific opioid prescribing recommendations on opioid stewardship following pelvic organ prolapse surgery

Linder, Brian J.; Occhino, John A.; Wiest, Sheila R.; Klingele, Christopher J.; Trabuco, Emanuel C.; Gebhart, John B.

doi:10.1016/j.ajog.2019.06.023

Cited by 26 publications

(55 citation statements)

References 18 publications

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“…Of the 8,904 patients from 22 studies used for the qualitative review, 4,560 patients were in the pre-intervention cohort and 4,251 patients in the post-intervention cohort. 10–32 Direct interventions to reduce opioid prescriptions were evaluated in 16 studies 11,12,14,15,18–21,25–29,31 (7,086 patients), while 6 studies 10,13,16,24,30,32 (1,818 patients) evaluated the effects of various indirect interventions. In 12 studies, 10,11,14,16,19,21,24–26,29,30,32 the procedures were categorized as major surgery, while 7 studies 12,13,18,20,22,23,27 included minor procedure and 3 studies 16,28,31 included both.…”

Section: Resultsmentioning

confidence: 99%

“…10–32 Direct interventions to reduce opioid prescriptions were evaluated in 16 studies 11,12,14,15,18–21,25–29,31 (7,086 patients), while 6 studies 10,13,16,24,30,32 (1,818 patients) evaluated the effects of various indirect interventions. In 12 studies, 10,11,14,16,19,21,24–26,29,30,32 the procedures were categorized as major surgery, while 7 studies 12,13,18,20,22,23,27 included minor procedure and 3 studies 16,28,31 included both. All studies were either case-control or cohort studies, and there were no reports from randomized controlled trials.…”

Section: Resultsmentioning

confidence: 99%

“…Thirteen studies 11,12,14,15,18–23,25,28,31 (6,503 patients) reported the effectiveness of direct interventions and 6 studies 10,13,16,24,30,32 (1,815 patients) evaluated the effectiveness of indirect interventions. There was significant reduction in mean prescribed opioids following both the direct (−76.68 MME, 95% CI 60.04–93.31, p <0.001) and the indirect interventions (−46.72 MME, 95% CI 24.20–69.23, p <0.001).…”

Section: Resultsmentioning

confidence: 99%

“…Sixteen studies provided data on the type of procedures performed which could be categorized as either major (10 studies, 10,11,14,16,19,21,24,25,30,32 3,062 patients) or minor surgery (6 studies, 12,13,18,20,22,23 1,547 patients). Significant reduction in opioid prescriptions was noted within each surgical category.…”

Section: Resultsmentioning

confidence: 99%

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Interventions to Reduce Opioid Prescriptions following Urological Surgery: A Systematic Review and Meta-Analysis

et al. 2022

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Purpose: Opioid prescriptions after surgery are major contributors to the opioid abuse epidemic. Several measures designed to limit opioid prescriptions at discharge have been evaluated. We conducted a comprehensive review and metaanalysis of the effectiveness of various types of interventions in reducing opioid prescriptions after urological surgery. Materials and Methods: A systematic review including MEDLINEÒ, Web of ScienceÔ and Cochrane databases was conducted to identify studies on opioid prescriptions and urological surgery. Twenty-two studies met the inclusion criteria, of which 19 were used for quantitative analysis for reduction in opioid prescriptions. Additional outcomes included opioid consumption and satisfaction with analgesia. Results: Of the 8,318 patients, 53% were in the pre-and 47% in the postintervention cohort. Overall mean reduction/patient in prescribed opioids was À67.59 (95% CI 54.23 to 80.94) morphine milligram equivalents (MME). Direct interventions, implemented by providers within their local department or hospital, were more effective in reducing prescribed opioids compared to indirect, or systemic, interventions, at À76.68 MME (95% CI 60.04 to À93.31) vs À46.72 MME (95% CI 24.20 to À69.23; p[0.04). Opioid consumption significantly decreased post-intervention with a mean reduction of -18.31 MME (95% CI 7.89 to 28.72). Patient satisfaction with analgesia remained unchanged between the pre-and post-intervention groups. Conclusions: Successful reduction in opioid prescriptions, without compromising pain control, can be achieved through a variety of interventions. Direct interventions appear to have a greater impact than indirect interventions in reducing opioid prescriptions. Despite the reduction, unused, excess prescription opioids were still noted, which provides an opportunity for further control on opioid prescriptions.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Interventions to Reduce Opioid Prescriptions following Urological Surgery: A Systematic Review and Meta-Analysis

et al. 2022

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“…The few studies using real consumption data to guide post-surgical prescribing have demonstrated significant clinical improvement in opioid prescribing patterns. 2,[4][5][6][7] However, only a few groups have collected this data at scale because it requires significant resources and is labor-intensive to collect.…”

Section: Introductionmentioning

confidence: 99%

Nonresponse adjustment using clinical and perioperative patient characteristics is critical for understanding post-discharge opioid consumption

Kennedy

et al. 2021

Preprint

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Background: Post-discharge opioid consumption is an important source of data in guiding appropriate opioid prescribing guidelines, but its collection is tedious and requires significant resources. Furthermore, the reliability of post-discharge opioid consumption surveys is unclear. Our group developed an automated short messaging service (SMS)-to-web survey for collecting this data from patients. In this study, we assessed its effectiveness in estimating opioid consumption by performing causal adjustment and comparison to a phone-based survey as reference. Methods: Patients who underwent surgical procedures at our institution from 2019-2020 were sent an SMS message with a link to a secure web survey to quantify opioids consumed after discharge. Several patient factors extracted from the EHR were tested for association with survey response. Following targeted learning (TL) nonresponse adjustment using these EHR-based factors, opioid consumption survey results were compared to a prior telephone-based survey at our institution as a reference. Results: 6,553 patients were included. Opioid consumption was measured in 2,883 (44%), including 1,342 (20.5%) through survey response. Characteristics associated with inability to measure opioid consumption included age, length of stay, race, tobacco use, and missing preoperative assessment. Among the top 10 procedures by volume, EHR-based TL nonresponse bias adjustment corrected the median opioid consumption reported by an average of 57%, and corrected the 75th percentile of reported consumption by an average of 11%. This brought median estimates for 6/10 procedures closer to telephone survey-based consumption estimates, and 75th percentile estimates for 3/10 procedures closer to telephone survey-based consumption estimates. Conclusion: We found that applying electronic health record (EHR)-based machine learning nonresponse bias adjustment is essential for debiased opioid consumption estimates from patient surveys. After adjustment, post-discharge surveys can generate reliable opioid consumption estimates. Clinical factors from the EHR combined with TL adjustment appropriately capture differences between responders and nonresponders and should be used prior to generalizing or applying opioid consumption estimates to patient care.

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Impact of enhanced recovery implementation in women undergoing abdominal sacrocolpopexy

Trad

Tamhane

Weaver

et al. 2022

Intl J Gynecology & Obste

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Enhanced recovery after surgery (ERAS) programs are based on multidisciplinary collaboration and are designed to mitigate the surgical stress response and hasten convalescence. 1,2 ERAS implementation substantially reduces hospital length of stay (LOS), opioid use, and costs while maintaining stable readmission rates and pain scores. 3 Studies regarding ERAS have focused primarily on oncologic procedures in gynecologic and colorectal surgery. 4,5 Yet, variability continues between specific components of ERAS pathways across and within surgical specialties. Driver elements accounting for the heterogeneous impact of ERAS on perioperative outcomes in gynecologic surgery need to be determined, with most previously assessed protocols not including incisional infiltration with liposomal bupivacaine (LB).

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Assessing the impact of procedure-specific opioid prescribing recommendations on opioid stewardship following pelvic organ prolapse surgery

Cited by 26 publications

References 18 publications

Interventions to Reduce Opioid Prescriptions following Urological Surgery: A Systematic Review and Meta-Analysis

Interventions to Reduce Opioid Prescriptions following Urological Surgery: A Systematic Review and Meta-Analysis

Nonresponse adjustment using clinical and perioperative patient characteristics is critical for understanding post-discharge opioid consumption

Impact of enhanced recovery implementation in women undergoing abdominal sacrocolpopexy

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