Decreasing opioid use in postoperative gynecologic oncology patients through a restrictive opioid prescribing algorithm

Boitano, Teresa; Sanders, Lucy J.; Gentry, Zachary L.; Smith, Haller J.; Leath, Charles A.; Xhaja, Anisa; Leal, Laura; Todd, Allison; Straughn, J. Michael

doi:10.1016/j.ygyno.2020.09.014

Cited by 15 publications

(10 citation statements)

References 20 publications

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“…While we did show that a decrease in narcotic prescribing is not associated with an increase clinic burden, the overall number of narcotics given is still relatively high and is higher than other institutional standards. Other studies have demonstrated that opioids can be decreased further without increasing number of opioid refill requests or decreasing patient satisfaction [26]. This may lay groundwork for establishing restrictive opioid prescribing protocols for gynecologic oncology population without fear of worsening patient experiences or increasing clinic staff burden.…”

Section: Discussionmentioning

confidence: 98%

Enhanced recovery after surgery (ERAS) protocol is associated with lower post-operative opioid use and a reduced office burden after minimally invasive surgery

Levytska

Wally

et al. 2022

Gynecologic Oncology

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Section: Discussionmentioning

confidence: 98%

Enhanced recovery after surgery (ERAS) protocol is associated with lower post-operative opioid use and a reduced office burden after minimally invasive surgery

Levytska

Wally

et al. 2022

Gynecologic Oncology

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“…Additional studies should also be performed to validate restrictive opioid prescribing which has shown no increase in refill requests and reduces the need to locate proper disposal avenues. 22 …”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Postoperative Narcotic Use in Benign, Minimally-Invasive Gynecologic Surgery

Frost

Kohn

Wang

et al. 2022

JSLS

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Background and Objectives: To evaluate postoperative opioid use after benign minimally-invasive gynecologic surgery and assess the impact of a patient educational intervention regarding proper opioid use/disposal. Methods: Educational pamphlets were provided preoperatively. Patients underwent hysterectomy, myomectomy, or other laparoscopic procedures. Opioid prescriptions were standardized with 25 tablets oxycodone 5mg for hysterectomy/myomectomy, 10 tablets oxycodone 5mg for LSC (oral morphine equivalents were maintained for alternatives). Pill diaries were reviewed and patient surveys completed during postoperative visits. Results: Of 106 consented patients, 65 (61%) completed their pill diaries. Median opioid use was 35 OME for hysterectomy (∼5 oxycodone tablets; IQR 11.25-102.5), 30 OME for myomectomy (∼4 tablets; IQR 15-75), and 18.75 OME for laparoscopy (∼3 tablets; IQR 7.5-48.75). Median last post-operative day (d) of use was 3d for hysterectomy (IQR 2, 8), 4d for myomectomy (IQR 1, 7), and 2d for laparoscopy (IQR 0.5-3.5). One patient (myomectomy) required a refill of 5mg oxycodone. No difference was found between total opioid use and presence of pelvic pain, chronic pain disorders, or psychiatric co-morbidities. Overall satisfaction with pain control (>4 on a 5-point Likert scale) was 91% for hysterectomy, 100% for myomectomy, 83% for laparoscopy. Of the 33 patients who read the pamphlet, 32(97%) felt it increased their awareness. Conclusion: Most patients required <10 oxycodone 5mg tablets, regardless of procedure with excellent patient satisfaction. A patient education pamphlet is a simple method to increase knowledge regarding the opioid epidemic and facilitate proper medication disposal.

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“…18,19 Existing protocols have utilized patient or surgical characteristics or inpatient opioid consumption to derive postdischarge opioid prescription amounts. 17,[20][21][22][23] However, these protocols can be unwieldy, requiring the practitioner to ascertain and input many different variables to determine an opioid amount, or are ill-suited for outpatient procedures. A more straightforward approach is to utilize procedure type to inform opioid prescription quantity.…”

Section: Reconstructive Original Articlementioning

confidence: 99%

Reducing Opioid Overprescribing through Procedure-specific Prescribing Guidelines

Zhang

Blum

Chu

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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Background: Despite advances in opioid-sparing pain management, postdischarge opioid overprescribing in plastic surgery remains an issue. Procedure-specific prescribing protocols have been implemented successfully in other surgical specialties but not broadly in plastic surgery. This study examined the efficacy of procedure-specific prescribing guidelines for reducing postdischarge opioid overprescribing. Methods: A total of 561 plastic surgery patients were evaluated retrospectively after a prescribing guideline, which recommended postdischarge prescription amounts based on the type of operation, was introduced in July 2020. Prescription and postdischarge opioid consumption amounts before (n = 428) and after (n = 133) guideline implementation were compared. Patient satisfaction and prescription frequency of nonopioid analgesia were also compared. Results: The average number of opioid pills per prescription decreased by 25% from 19.3 (27.4 OME) to 15.0 (22.7 OME; P = 0.001) after guideline implementation, with no corresponding decrease in the average number of postdischarge opioid pills consumed [10.6 (15.1 OME) to 8.2 (12.4 OME); P = 0.147]. Neither patient satisfaction with pain management (9.6‐9.6; P > 0.99) nor communication (9.6‐9.5; P > 0.99) changed. The rate of opioid-only prescription regimens decreased from 17.9% to 7.6% (P = 0.01), and more patients were prescribed at least two nonopioid analgesics (27.5% to 42.9%; P = 0.003). The rate of scheduled acetaminophen prescription, in particular, increased (54.7% to 71.4%; P = 0.002). Conclusions: A procedure-specific prescribing model is a straight-forward intervention to promote safer opioid-prescribing practices in plastic surgery. Its usage in clinical practice may lead to more appropriate opioid prescribing.

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Decreasing opioid use in postoperative gynecologic oncology patients through a restrictive opioid prescribing algorithm

Cited by 15 publications

References 20 publications

Enhanced recovery after surgery (ERAS) protocol is associated with lower post-operative opioid use and a reduced office burden after minimally invasive surgery

Enhanced recovery after surgery (ERAS) protocol is associated with lower post-operative opioid use and a reduced office burden after minimally invasive surgery

Risk Factors for Postoperative Narcotic Use in Benign, Minimally-Invasive Gynecologic Surgery

Reducing Opioid Overprescribing through Procedure-specific Prescribing Guidelines

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