Reduction in Prescribed Opioids after General Surgery Procedures at a Public Hospital

Abstract

Overdose of opioids is the number one cause of accidental death in the United States, and surgeons are overprescribing these medications. The aim of this study was to assess the feasibility of implementing postoperative opioid prescribing guidelines for general surgery procedures at a public hospital, where patients have lower socioeconomic status, public insurance, and limited access to care. We implemented a quality improvement project, which included in-service training for surgical staff and distribution of standardized guidelines. An infographic for patients was created to facilitate education on postoperative pain management. Pre- and postintervention opioid prescriptions and emergency room visits were compared for patients undergoing common general surgery procedures (inguinal hernia repair, appendectomy, and laparoscopic cholecystectomy). The median number of narcotic pills prescribed significantly decreased from 30 (n = 64) to 15 (n = 63) after the intervention ( P < 0.0001). Morphine milligram equivalents decreased from a median [range] of 150 [20,600] to 90 [5,300] ( P < 0.0001). The percentage of patients with postoperative pain-related emergency department visits remained low (1.6%). Standardization of postoperative opioid prescription practices was successfully implemented at a public hospital without an increase in the number of emergency room visits for pain.

Development and design of a mobile application for prescription opioid clinical decision-making: a feasibility study in New York City, USA

“… 15 Recent opioid prescribing recommendations for patients undergoing a laparoscopic cholecystectomy range from 0 to 15 oxycodone or equivalent pills. 16 17 …”

“…Among a recent cohort of patients undergoing both laparoscopic cholecystectomies and appendectomies, the average number of opioid pills taken postdischarge was 1.8 oxycodone pills 15. Recent opioid prescribing recommendations for patients undergoing a laparoscopic cholecystectomy range from 0 to 15 oxycodone or equivalent pills 16 17…”

Perioperative Pain Management Issues Unique to Older Adults Undergoing Surgery

“…16 – 18 Infographics and visuals about pain management with easy to understand language can also be useful in the preoperative setting. A recent single-institution study by Angelo et al 19 showed that a patient-friendly infographic in the preoperative area listing the common “do’s and don’ts” of pain medications was a useful adjunct to help decrease opioid consumption postoperatively.…”

“…Easy to follow instructions and patient infographics for pain after surgery can be used to reinforce the importance of these topics. 19 Equally important, the older adult should be counseled on mobility exercises (eg, daily walking program) to perform after discharge to prevent functional decline and must be informed that these may also be associated with some pain and discomfort. 84 At the same time, it is important that the older adult treats his or her pain adequately so as to not impair function.…”

Transforming Prescription Opioid Practices in Primary Care With Change Theory

“…There is reliable evidence the introduction of opioid guidelines for primary care have had positive effect on overprescribing. 7 , 8 Other evidence suggests the implementation of opioid prescribing laws is not associated with decline in prescription opioids. 9 More importantly, there is credible proof the guideline left many chronic pain patients stranded with inadequate analgesic coverage.…”