Safety and Feasibility of Discharge Without an Opioid Prescription for Patients Undergoing Gynecologic Surgery

Abstract

OBJECTIVE: To implement a quality-improvement intervention aimed at reducing unnecessary opioid prescriptions for patients who are undergoing gynecologic surgery. METHODS: This was a retrospective cohort study that included data from the pre– and post–quality-improvement initiative cohorts. Patients at an urban, tertiary academic medical center who were undergoing scheduled minimally invasive surgery and open abdominal surgery by a gynecologic oncologist were included. Patients underwent preoperative counseling, standardization of perioperative analgesia, and a postoperative opioid prescribing algorithm. Descriptive statistics were calculated for demographic and perioperative characteristics, process measures, and outcome measures. RESULTS: A total of 532 abdominal surgeries were analyzed. The total percentage of patients discharged with an opioid prescription decreased from 82.7% (n=229/276) to 23.1% (n=59/256) (P<.001) and was significantly reduced for all routes of surgery. The mean number of opioid tablets prescribed for all patients was significantly reduced from 7.2 tablets (SD=5.7) to 1.8 tablets (SD=4.3) (P<.001). Eighty-three percent of patients (n=97/117) who underwent minimally invasive hysterectomy and were discharged on postoperative day 0 or day 1 were not provided an opioid prescription. Fifty-one percent of patients who underwent laparotomy were discharged without an opioid prescription. The percentage of patients who required an opioid refill or new prescription in the preintervention and postintervention cohorts remained constant (6.5%, n=18/276 vs 5.9%, n=15/256, P=.75), as did postoperative calls for pain (8.3%, n=23/276 vs 10.9%, n=33/256). CONCLUSION: Patients who are undergoing scheduled abdominal gynecologic surgery can be safely discharged without opioid prescriptions with appropriate education and perioperative analgesia prescribing practices. These protocols and prescribing practices profoundly limit opioid prescriptions, which is an important factor in combating the ongoing opioid crisis.

Preemptive local analgesia at vaginal hysterectomy: a systematic review

“…All four trials in this review found reduced postoperative opioid requirements during the first 24 h after surgery [23][24][25][26]. Many concepts have been implemented in the last few years to reduce postoperative opioid needs in gynecologic patients, including a shared decision-making model [14], change in discharge regimes in minimal invasive surgeries [13] and a quality improvement intervention protocol [12]. Systemic approaches to multimodal analgesia have included systemic administration of acetaminophen and anti-inflammatory drugs and gabapentin [31][32][33][34][35][36][37].…”

“…The reduction of opioid requirements is of particular significance considering the potential for misuse of these agents [8][9][10], their side effects and higher costs for the health care system [7]. Recently attempts have been made to improve multimodal perioperative analgesia [8,9,[11][12][13][14][15][16][17][18][19]. Due to the opioid crisis, there is high interest in reducing perioperative opioid use.…”