Standardizing Opioid Prescriptions to Patients After Ambulatory Oncologic Surgery Reduces Overprescription

Fearon, Nkechi; Benfante, Nicole; Assel, Melissa; Chesnut, Gregory T.; Levine, Marcia; Broach, Vance; Simon, Brett A.; Twersky, Rebecca S.; Laudone, Vincent P.

doi:10.1016/j.jcjq.2020.04.004

Cited by 14 publications

(28 citation statements)

References 34 publications

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“…Nineteen studies (8,407 patients; 4,443 in the pre- and 4,031 in the post-intervention cohort) reported sufficient data on prescribed opioids in both cohorts to allow for pooled analysis. 10–25,28,30–32 A significant reduction in prescribed opioids at discharge was noted in all except 1 study following the implementation of various interventions. The mean overall reduction in the post-intervention cohort was −67.59 MME (95% CI 54.23–80.94, p <0.001, I 2 =95%; fig.…”

Section: Resultsmentioning

confidence: 91%

“…10–32 Direct interventions to reduce opioid prescriptions were evaluated in 16 studies 11,12,14,15,18–21,25–29,31 (7,086 patients), while 6 studies 10,13,16,24,30,32 (1,818 patients) evaluated the effects of various indirect interventions. In 12 studies, 10,11,14,16,19,21,24–26,29,30,32 the procedures were categorized as major surgery, while 7 studies 12,13,18,20,22,23,27 included minor procedure and 3 studies 16,28,31 included both. All studies were either case-control or cohort studies, and there were no reports from randomized controlled trials.…”

Section: Resultsmentioning

confidence: 99%

“…Thirteen studies 11,12,14,15,18–23,25,28,31 (6,503 patients) reported the effectiveness of direct interventions and 6 studies 10,13,16,24,30,32 (1,815 patients) evaluated the effectiveness of indirect interventions. There was significant reduction in mean prescribed opioids following both the direct (−76.68 MME, 95% CI 60.04–93.31, p <0.001) and the indirect interventions (−46.72 MME, 95% CI 24.20–69.23, p <0.001).…”

Section: Resultsmentioning

confidence: 99%

“…Seven studies (1,872 patients) provided data on the use of prescribed opioids by the patients. 11,14,15,21,23,25,28 Five of the 7 studies demonstrated significant reductions in opioids used by patients, while the remaining 2 studies showed a nonsignificant reduction. 11,15,23,25,28 The mean overall reduction in the opioid used per patient was −18.31 MME (95% CI 7.89–28.72, p <0.0001; fig.…”

Section: Resultsmentioning

confidence: 99%

“…Of the 8,904 patients from 22 studies used for the qualitative review, 4,560 patients were in the pre-intervention cohort and 4,251 patients in the post-intervention cohort. 10–32 Direct interventions to reduce opioid prescriptions were evaluated in 16 studies 11,12,14,15,18–21,25–29,31 (7,086 patients), while 6 studies 10,13,16,24,30,32 (1,818 patients) evaluated the effects of various indirect interventions. In 12 studies, 10,11,14,16,19,21,24–26,29,30,32 the procedures were categorized as major surgery, while 7 studies 12,13,18,20,22,23,27 included minor procedure and 3 studies 16,28,31 included both.…”

Section: Resultsmentioning

confidence: 99%

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Interventions to Reduce Opioid Prescriptions following Urological Surgery: A Systematic Review and Meta-Analysis

et al. 2022

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Purpose: Opioid prescriptions after surgery are major contributors to the opioid abuse epidemic. Several measures designed to limit opioid prescriptions at discharge have been evaluated. We conducted a comprehensive review and metaanalysis of the effectiveness of various types of interventions in reducing opioid prescriptions after urological surgery. Materials and Methods: A systematic review including MEDLINEÒ, Web of ScienceÔ and Cochrane databases was conducted to identify studies on opioid prescriptions and urological surgery. Twenty-two studies met the inclusion criteria, of which 19 were used for quantitative analysis for reduction in opioid prescriptions. Additional outcomes included opioid consumption and satisfaction with analgesia. Results: Of the 8,318 patients, 53% were in the pre-and 47% in the postintervention cohort. Overall mean reduction/patient in prescribed opioids was À67.59 (95% CI 54.23 to 80.94) morphine milligram equivalents (MME). Direct interventions, implemented by providers within their local department or hospital, were more effective in reducing prescribed opioids compared to indirect, or systemic, interventions, at À76.68 MME (95% CI 60.04 to À93.31) vs À46.72 MME (95% CI 24.20 to À69.23; p[0.04). Opioid consumption significantly decreased post-intervention with a mean reduction of -18.31 MME (95% CI 7.89 to 28.72). Patient satisfaction with analgesia remained unchanged between the pre-and post-intervention groups. Conclusions: Successful reduction in opioid prescriptions, without compromising pain control, can be achieved through a variety of interventions. Direct interventions appear to have a greater impact than indirect interventions in reducing opioid prescriptions. Despite the reduction, unused, excess prescription opioids were still noted, which provides an opportunity for further control on opioid prescriptions.

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Section: Resultsmentioning

confidence: 91%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Interventions to Reduce Opioid Prescriptions following Urological Surgery: A Systematic Review and Meta-Analysis

et al. 2022

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Implementation and Assessment of No Opioid Prescription Strategy at Discharge After Major Urologic Cancer Surgery

et al. 2023

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ImportancePostoperative opioid prescriptions are associated with delayed recovery, perioperative complications, opioid use disorder, and diversion of overprescribed opioids, which places the community at risk of opioid misuse or addiction.ObjectiveTo assess a protocol for eliminating postdischarge opioid prescriptions after major urologic cancer surgery.Design, Setting, and ParticipantsThis cohort study of the no opioid prescriptions at discharge after surgery (NOPIOIDS) protocol was conducted between May 2017 and June 2021 at a tertiary referral center. Patients undergoing open or minimally invasive radical cystectomy, radical or partial nephrectomy, and radical prostatectomy were sorted into the control group (usual opioids), the lead-in group (reduced opioids), and the NOPIOIDS group (no opioid prescriptions).InterventionsThe NOPIOIDS group received a preadmission educational handout, postdischarge instructions for using nonopioid analgesics, and no routine opioid prescriptions. The lead-in group received a postdischarge instruction sheet and reduced opioid prescriptions at prescribers’ discretion. The control group received opioid prescriptions at prescribers’ discretion.Main Outcomes and MeasuresPrimary outcome measures included rate and dose of opioid prescriptions at discharge and for 30 days postdischarge. Additional outcome measures included patient-reported pain and satisfaction level, unplanned health care utilization, and postoperative complications.ResultsOf 647 opioid-naive patients (mean [SD] age, 63.6 [10.0] years; 478 [73.9%] male; 586 [90.6%] White), the rate of opioid prescriptions at discharge for the control, the lead-in, and the NOPIOIDS groups was 80.9% (157 of 194), 57.9% (55 of 95), and 2.2% (8 of 358) (Kruskal-Wallis test of medians: P &lt; .001), and the overall median (IQR) tablets prescribed was 14 (10-20), 4 (0-5.3), and 0 (0-0) per patient in the control, lead-in, and NOPIOIDS groups, respectively (Kruskal-Wallis test of medians: P &lt; .001). In the NOPIOIDS group, median and mean opioid dose was 0 tablets for all procedure types, with the exception of kidney procedures (mean [SD], 0.5 [1.7] tablets). Patient-reported pain surveys were received from 358 patients (72.6%) in the NOPIOIDS group, demonstrating low pain scores (mean [SD], 2.5 [0.86]) and high satisfaction scores (mean [SD], 86.6 [3.8]). There was no increase in postoperative complications in the group with no opioid prescriptions.Conclusions and RelevanceThis perioperative protocol, with emphasis on nonopioid alternatives and patient instructions, may be safe and effective in nearly eliminating the need for opioid prescriptions after major abdominopelvic cancer surgery without adversely affecting pain control, complications, or recovery.

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Reducing opioid prescribing after ambulatory breast reconstruction surgery

Fearon,

Kurtzman,

Benfante

et al. 2023

Journal of Surgical Oncology

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BackgroundThe lack of evidence‐based guidelines for postoperative opioid prescriptions following breast reconstruction contributes to a wide variation in prescribing practices and increases potential for misuse and abuse.MethodsBetween August and December 2019, women who underwent outpatient breast reconstruction were surveyed 7–10 days before (n = 97) and after (n = 101) implementing a standardized opioid prescription reduction initiative. We compared postoperative opioid use, pain control, and refills in both groups. Patient reported outcomes were compared using the BREAST‐Q physical wellbeing of the chest domain and a novel symptom Recovery Tracker.ResultsBefore changes in prescriptions, patients were prescribed a median of 30 pills and consumed three pills (interquartile range [IQR: 1,9]). After standardization, patients were prescribed eight pills and consumed three pills (IQR: 1,6). There was no evidence of a difference in the proportion of patients experiencing moderate to very severe pain on the Recovery Tracker or in the early BREAST‐Q physical wellbeing of the chest scores (p = 0.8 and 0.3, respectively).ConclusionStandardizing and reducing opioid prescriptions for patients undergoing reconstructive breast surgery is feasible and can significantly decrease the number of excess pills prescribed. The was no adverse impact on early physical wellbeing, although larger studies are needed to obtain further data.

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Standardizing Opioid Prescriptions to Patients After Ambulatory Oncologic Surgery Reduces Overprescription

Cited by 14 publications

References 34 publications

Interventions to Reduce Opioid Prescriptions following Urological Surgery: A Systematic Review and Meta-Analysis

Interventions to Reduce Opioid Prescriptions following Urological Surgery: A Systematic Review and Meta-Analysis

Implementation and Assessment of No Opioid Prescription Strategy at Discharge After Major Urologic Cancer Surgery

Reducing opioid prescribing after ambulatory breast reconstruction surgery

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