Spillover Effect of Evidence-Based Postoperative Opioid Prescribing

Howard, Ryan; Alameddine, Mitchell; Klueh, Michael P; Englesbe, Michael J.; Brummett, Chad M.; Waljee, Jennifer F.; Lee, Jay

doi:10.1016/j.jamcollsurg.2018.06.007

Cited by 54 publications

(38 citation statements)

References 22 publications

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“…Our review found that prescribing guidelines are almost universally effective in reducing opioid prescriptions after surgery [3,9,11,27,28]. Given a lack of hard data on the "appropriate minimum quantity" of opioids to prescribe after many procedures [14], a consensus method may be employed to formulate institutional guidelines [28].…”

Section: Discussionmentioning

confidence: 99%

“…After the introduction of provider education and guidelines, investigators found reductions in post-operative prescriptions ranging from 42.9 to 176.0% [3,6,9,28]. Such guidelines may also reduce opioid prescribing for other procedures simply by increasing physician awareness [11]. The role of nurses in the bedside evaluation of patients' pain was also an area for potential intervention.…”

Section: Provider-focused Interventionsmentioning

confidence: 99%

See 1 more Smart Citation

Fighting Back: Institutional Strategies to Combat the Opioid Epidemic: A Systematic Review

Lovecchio

Premkumar

Stepan

et al. 2019

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

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Background: Current research on opioid use within orthopedic surgery has focused on efforts to identify patients at risk for chronic opioid use. Studies addressing prevention of opioid misuse related to orthopedic care are lacking. Evidence-based interventions to reduce the reliance on opioids for post-operative pain relief will be a key component of any comprehensive institutional opioid policy. Questions/Purposes: The purpose of this systematic review was to evaluate institutional strategies that reduce opioid administration or consumption after orthopedic surgery. Methods: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist, a search was conducted of the PubMed database for English-language articles that analyzed interventions by physicians, nurses, pharmacists, physical therapists, or other hospital staff to reduce postoperative opioid use or narcotic prescription amounts after surgery. Studies that contained objective outcome measures (i.e., no expert opinion articles) were selected. Investigations on the effect of pharmacologic adjuvants, cryotherapy, or regional nerve blockades on opioid use were excluded. Results: The initial search yielded 6598 titles, of which 13 full-text articles were ultimately selected for inclusion in this systematic review. The review identified two major categories of interventions-patientfocused and provider-focused (e.g., physicians, nurses, physical therapists, pharmacists). Formal patient education programs were most effective in reducing opioid use. On the provider side, prescribing guidelines appear to decrease the overall number of pills prescribed, often without changes in patient satisfaction or requests for refills. Conclusions: Researchers are just beginning to establish the most effective ways for institutions to reduce opioid use and promote responsible post-operative prescribing. Institutional prescribing guidelines, standardized bedside pain-management programs, and formal patient education curriculums are all evidence-based interventions that can achieve these goals. The available research also supports an interprofessional approach in any institutional opioid-reduction strategy.

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Section: Discussionmentioning

confidence: 99%

Section: Provider-focused Interventionsmentioning

confidence: 99%

Fighting Back: Institutional Strategies to Combat the Opioid Epidemic: A Systematic Review

Lovecchio

Premkumar

Stepan

et al. 2019

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

View full text Add to dashboard Cite

show abstract

“…These recommendations should be used as a basis for a prospective trial. As has been found in similar studies in the adult population, these evidence-based data may have spillover effects in driving opioid dosages down for other pediatric operations as providers extrapolate the data [43,44]. This guideline should be considered for use by pediatric and adult surgeons alike as well as their trainees and advanced practice providers to inform decisions toward minimal opioid prescriptions in this population.…”

Section: Discussionmentioning

confidence: 92%

An Evidence-Based Guideline Supporting Restricted Opioid Prescription after Pediatric Appendectomy

Freedman-Weiss

Chiu

Worhunsky

et al. 2020

Journal of Pediatric Surgery

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“…Thus, targeting hospital level factors as part of a multifaceted strategy may enable development of sustainable best practices that residents can carry forward in their future surgical careers. Previous work by Howard et al has noted the unintentional benefits in prescribing habits across surgeries, named the "spillover effect 41 ," caused by evidence-based guidelines imposed on a distinct procedure. These interventions at the hospital level additionally hold promise to reduce opioid prescribing across other factors in perhaps a similar manner.…”

Section: Discussionmentioning

confidence: 99%

A statewide comparison of opioid prescribing in teaching versus nonteaching hospitals

Cron

Hwang

et al. 2019

Surgery

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Background: Postoperative opioid prescribing is often excessive, but the differences in opioid prescribing between teaching hospitals and non-teaching hospitals is not well understood. Given the workload of surgical training and frequent turnover of prescribers on surgical services, we hypothesized that postoperative opioid prescribing would be higher among teaching compared to non-teaching hospitals. Study design: We used insurance claims from a statewide quality collaborative in Michigan to identify 17,075 opioid-naïve patients who underwent 22 surgical procedures across 76 hospitals from 2012-2016. Our outcomes included 1) the amount of opioid prescribed for the initial postoperative prescription in oral morphine equivalents [OME] and 2) high risk prescribing in the 30 days after surgery (high daily dose [≥100 OME], new long-acting/extended-release opioid, overlapping prescriptions, or concurrent benzodiazepine prescription). Teaching hospital status was obtained from the 2014 American Hospital Association survey. Multilevel regression was used to adjust for patient and procedural factors and to perform reliability adjustment. Results: The amount of opioid prescribed per initial opioid prescription varied 4.7-fold across all hospitals from 130 OME to 616 OME. Patients discharged from teaching hospitals filled larger initial opioid prescriptions overall compared with non-teaching hospitals (251 OME vs. 232

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Spillover Effect of Evidence-Based Postoperative Opioid Prescribing

Cited by 54 publications

References 22 publications

Fighting Back: Institutional Strategies to Combat the Opioid Epidemic: A Systematic Review

Fighting Back: Institutional Strategies to Combat the Opioid Epidemic: A Systematic Review

An Evidence-Based Guideline Supporting Restricted Opioid Prescription after Pediatric Appendectomy

A statewide comparison of opioid prescribing in teaching versus nonteaching hospitals

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