BACKGROUND: Overprescribing of opioids after surgery contributes to long-term abuse. Evaluating opioid prescription patterns and patient-reported opioid use offers an evidence-based method to identify potential overprescription. This quality improvement initiative aimed to reduce and standardize opioid prescriptions upon discharge from an ambulatory oncologic surgery center and evaluate the effect of this change on patients' subsequent opioid use and reported pain. METHODS: Between March 2018 and January 2019, consecutive opioid-naïve patients aged ≥ 18 years who underwent robotic or laparoscopic hysterectomy, radical prostatectomy, or partial nephrectomy, or total mastectomy with or without immediate reconstruction were surveyed 7-10 days postoperatively. Data collected in the pre- (n = 551) and post-standardization (n = 480) cohorts included perception of pain relief, opioids prescribed (verified by electronic medical record review) and consumed, and refills received. RESULTS: Pre-standardization, the median opioid prescription at discharge was 20 pills (interquartile range [IQR] 20-28) or 140 oral morphine milligram equivalents (MME) (IQR 100-150). Median opioid consumption was 2 pills (IQR 0-7) or 10 MME (IQR 0-40) among all services. Opioid prescriptions were later standardized to 7, 8, and 10 pills (35, 40, and 75 MME), in the gynecology, urology, and breast services, respectively. The change was not associated with an increase in reported pain. Refill requests increased postintervention across all surgeries from 4.4% to 7.7%, with the largest increase among patients who underwent breast surgery. CONCLUSION: The number of opioid pills given at discharge to patients undergoing ambulatory or short-stay cancer surgery can safely be reduced.
BACKGROUND: Overprescribing of opioids after surgery contributes to long-term abuse. Evaluating opioid prescription patterns and patient-reported opioid use offers an evidence-based method to identify potential overprescription. This quality improvement initiative aimed to reduce and standardize opioid prescriptions upon discharge from an ambulatory oncologic surgery center and evaluate the effect of this change on patients' subsequent opioid use and reported pain. METHODS: Between March 2018 and January 2019, consecutive opioid-naïve patients aged ≥ 18 years who underwent robotic or laparoscopic hysterectomy, radical prostatectomy, or partial nephrectomy, or total mastectomy with or without immediate reconstruction were surveyed 7-10 days postoperatively. Data collected in the pre- (n = 551) and post-standardization (n = 480) cohorts included perception of pain relief, opioids prescribed (verified by electronic medical record review) and consumed, and refills received. RESULTS: Pre-standardization, the median opioid prescription at discharge was 20 pills (interquartile range [IQR] 20-28) or 140 oral morphine milligram equivalents (MME) (IQR 100-150). Median opioid consumption was 2 pills (IQR 0-7) or 10 MME (IQR 0-40) among all services. Opioid prescriptions were later standardized to 7, 8, and 10 pills (35, 40, and 75 MME), in the gynecology, urology, and breast services, respectively. The change was not associated with an increase in reported pain. Refill requests increased postintervention across all surgeries from 4.4% to 7.7%, with the largest increase among patients who underwent breast surgery. CONCLUSION: The number of opioid pills given at discharge to patients undergoing ambulatory or short-stay cancer surgery can safely be reduced.
Authors: Wesley Yip; Andrew B Chen; Cristin Malekyan; William Widjaja; Kevin Yan; Makela Stankey; Xue Sun; Akbar N Ashrafi; John N Graham; Shane C Dickerson; Mohamed H Eloustaz; Mihir M Desai; Inderbir S Gill; Monish Aron; Michael P Kim Journal: J Robot Surg Date: 2022-02-10
Authors: Kevin Berardino; Austin H Carroll; Daniel Popovsky; Robert Ricotti; Matthew D Civilette; William F Sherman; Alan D Kaye Journal: Orthop Rev (Pavia) Date: 2022-05-31
Authors: Matthew B Clements; Amy L Tin; Connie L Estes; Ghalib Jibara; Priyanka K Desai; Behfar Ehdaie; Karim A Touijer; Peter T Scardino; James A Eastham; Melissa J Assel; Andrew J Vickers; Brett A Simon; Vincent P Laudone Journal: J Urol Date: 2021-09-21 Impact factor: 7.600
Authors: Timothy P DiPeri; Timothy E Newhook; Ryan W Day; Yi-Ju Chiang; Whitney L Dewhurst; Elsa M Arvide; Morgan L Bruno; Christopher P Scally; Christina L Roland; Matthew H G Katz; Jean-Nicolas Vauthey; George J Chang; Brian D Badgwell; Nancy D Perrier; Elizabeth G Grubbs; Jeffrey E Lee; Ching-Wei D Tzeng Journal: Surg Open Sci Date: 2022-04-25
Authors: Allison Kirkegaard; Zachary Wagner; Louis T Mariano; Meghan C Martinez; Xiaowei Sherry Yan; Robert J Romanelli; Katherine E Watkins Journal: BMJ Open Date: 2022-09-19 Impact factor: 3.006