Effects of Shared Decision Making on Opioid Prescribing After Hysterectomy

Vilkins, Annmarie; Sahara, Michael; Till, Sara R.; Ceci, Christina; Howard, Ryan; Griffith, Kendall C.; Waljee, Jennifer F.; Lim, Courtney S.; Skinner, Bethany; Clauw, Daniel J.; Brummett, Chad M.; As‐Sanie, Sawsan

doi:10.1097/aog.0000000000003468

Cited by 33 publications

(29 citation statements)

References 26 publications

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“…In patients undergoing hysterectomies, those who participated in a preoperative patient education program consumed significantly fewer oral morphine equivalents at the time of discharge with no significant change in patient satisfaction or number of refills. This education program included a discussion of pain expectations and information regarding the mean number of opioids used by a similar cohort, and patients were then able to choose the number of opioids prescribed at discharge [ 19 ]. Similarly, a recently published randomized controlled trial examining the effect of opioid-related preoperative patient education on post-discharge opioid consumption in patients undergoing arthroscopic rotator cuff repair reported that preoperative patient education significantly decreased the number of opioid pills consumed at 3 months after surgery.…”

Section: Preoperative Interventionsmentioning

confidence: 99%

Reducing New Persistent Opioid Use After Surgery: A Review of Interventions

Burns

Urman

Pian

et al. 2021

Curr Pain Headache Rep

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Purpose of Review This review aims to summarize interventions used in the perioperative period to reduce the development of new persistent postoperative opioid use in opioid-naïve patients. Recent Findings The development of new persistent opioid use after surgery has recently been identified as a common postoperative complication. The existing literature suggests that interventions across the continuum of care have been shown to decrease the incidence of new persistent postoperative opioid use. Specific preoperative, intraoperative, and postoperative interventions will be reviewed, as well as the use of clinical pathways and protocols that span throughout the perioperative period. Common to many of these interventions include the use of multimodal analgesia throughout the perioperative period and an emphasis on a patient-centered, evidence-based approach to the perioperative pain management plan. Summary While the incidence of new persistent postoperative opioid use appears to be high, the literature suggests that there are both small- and large-scale interventions that can be used to reduce this. Technological advances including prescription monitoring systems and mobile applications have enabled studies to monitor opioid consumption after discharge. Interventions that occur preoperatively, such as patient education and expectation setting regarding postoperative pain management, and interventions that occur postoperatively, such as the implementation of procedure-specific, evidence-based prescribing guidelines and protocols, have been shown to reduce post-discharge opioid consumption. The use of multimodal analgesia and opioid-sparing adjuncts throughout the perioperative period is central to many of these interventions and has essentially become standard of care for management of perioperative pain.

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Section: Preoperative Interventionsmentioning

confidence: 99%

Reducing New Persistent Opioid Use After Surgery: A Review of Interventions

Burns

Urman

Pian

et al. 2021

Curr Pain Headache Rep

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“…During recent years, reports of differing strategies to decrease opioid Flowchart of patients included in the new departmental opioid-prescribing policy analysis before and after its implementation MATERNAL Original Research use for acute pain (ie, postoperative period) have been published, such as shared decision-making models for opioid prescriptions 8,9 and routine use of specialized inpatient order sets. 5,10 Specifically, for vaginal deliveries, recent work has highlighted a successful initiative to decrease inpatient opioid use.…”

Section: Resultsmentioning

confidence: 99%

Evaluation of a new departmental policy to decrease routine opioid prescribing after vaginal delivery

Olsen¹,

Eagan

Romutis

et al. 2020

American Journal of Obstetrics & Gynecology MFM

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BACKGROUND: In line with a nationwide commitment to decrease opioid prescribing, in October 2017, our department implemented a new departmental policy to cease routine provision of opioid prescriptions at the time of discharge following vaginal delivery. OBJECTIVE: This study aimed to evaluate the effect of this policy on the number of discharge opioid prescriptions provided and outpatient encounters observed postpartum. STUDY DESIGN: This was a retrospective cohort study of patients who underwent vaginal delivery at our institution from November 2016 to January 2018. We reviewed delivery and postpartum records for patients 18 years or older, without chronic opioid use or contraindication to nonsteroidal antiinflammatory medication use. The primary outcome was the proportion of patients provided with an opioid prescription at the time of discharge following vaginal delivery. The secondary outcome was the number of unscheduled patient encounters related to pain in the 6-week postpartum period. Fisher's exact test was used to compare these outcomes before and after implementation of the new departmental opioid-prescribing policy. RESULTS: A total of 1188 charts were reviewed; among those charts, 810 met the inclusion criteria. Notably, 405 patients delivered before the guideline, and 405 patients delivered after its implementation. After the implementation of the new departmental policy, there was a 10-fold decrease in opioid prescriptions provided from 323 (79.8%) to 29 (7.2%) (P<.01). Although the number of unscheduled outpatient encounters postpartum increased slightly from 22 to 37 encounters after the implementation of the new departmental policy, this difference was not statistically significant (P¼.08). CONCLUSION: Limiting opioid prescribing after vaginal delivery is associated with a considerable decrease in the number of discharge opioid prescriptions provided and does not significantly increase the number of outpatient encounters related to pain postpartum.

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“…42 Shared-decision making can further decrease opioid prescribing, without reducing patient satisfaction or postoperative pain control. 43 Tapentadol (a relatively new medication) may become an alternative to oxycodone. Some studies have shown similar analgesic efficacy to oxycodone, with less nausea and constipation.…”

Section: Postoperative Analgesiamentioning

confidence: 99%

“…Individual variability in patients’ postoperative opioid consumption means that clinicians should consider patient factors such as preoperative opioid use and history of endometriosis 42 . Shared‐decision making can further decrease opioid prescribing, without reducing patient satisfaction or postoperative pain control 43 …”

Section: Postoperative: In the Recovery Bay And/or Wardmentioning

confidence: 99%

Life in the laparoscopic fast lane: evidence‐based perioperative management and enhanced recovery in benign gynaecological laparoscopy

Bryant‐Smith¹,

As‐Sanie

Lloyd

et al. 2021

The Obstetric & Gynaecologis

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Enhanced recovery after surgery (ERAS) protocols aim to shorten the length of hospital stay and expedite recovery, without increasing complications or readmission rates. Implementation of ERAS protocols should be evidence-based, including when applied to pre-admission clinic (including preoperative investigations), fasting, antibiotic prophylaxis, thromboprophylaxis, analgesia, expeditious removal of urinary catheters and early mobilisation. Learning objectivesTo understand evidence-based perioperative management of patients undergoing laparoscopic procedures for benign gynaecological indications. To appraise critically the judicious ordering of preoperative investigations.To understand the importance of preoperatively assessing and managing each patient's risk of venous thromboembolism. To understand the key components of perioperative management that decrease surgical site infection(s). Ethical issuesPreoperative patient education is a vital component of perioperative management; written materials should be prepared in languages other than English to enable all patients to benefit from the ERAS approach. A balance must be found between applying ERAS protocols as a checklist to ensure all aspects of patient care have been considered and tailoring those protocols to each patient's individual needs.

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Effects of Shared Decision Making on Opioid Prescribing After Hysterectomy

Cited by 33 publications

References 26 publications

Reducing New Persistent Opioid Use After Surgery: A Review of Interventions

Reducing New Persistent Opioid Use After Surgery: A Review of Interventions

Evaluation of a new departmental policy to decrease routine opioid prescribing after vaginal delivery

Life in the laparoscopic fast lane: evidence‐based perioperative management and enhanced recovery in benign gynaecological laparoscopy

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