Avani R Patel1, Brooke Vuong2, Gillian E Kuehner3, Patience Odele4, Garner Low5, Alison Savitz6, Veronica Shim7, Margaret Mentakis2, Elizabeth Linehan8, Sharon B Chang9. 1. Department of Surgery, Kaiser Permanente Fremont Medical Center, Fremont, CA, USA. 2. Department of Surgery, Kaiser Permanente South Sacramento Medical Center, Sacramento, CA, USA. 3. Department of Surgery, Kaiser Permanente Vallejo Medical Center, Vallejo, CA, USA. 4. Department of Surgery, Kaiser Permanente San Rafael Medical Center, San Rafael, CA, USA. 5. Pharmacy Drug Use Management, Kaiser Permanente Northern California, Oakland, CA, USA. 6. Department of Surgery, Kaiser Permanente Walnut Creek Medical Center, Walnut Creek, CA, USA. 7. Department of Surgery, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA. 8. Department of Surgery, Kaiser Permanente San Francisco Medical Center, San Francisco, CA, USA. 9. Department of Surgery, Kaiser Permanente Fremont Medical Center, Fremont, CA, USA. sharon.b.chang@kp.org.
Abstract
BACKGROUND: Postoperative prescriptions have contributed to the opioid epidemic. In response, a large, integrated health care delivery system implemented initiatives to reduce outpatient opioid prescriptions. We evaluated the impact of these interventions on opioid-prescribing practices after breast surgery. METHODS: We examined postoperative prescribing practices before and after the 2016-2018 intervention period. Primary endpoints were the use of non-opioid regimens (NORs) and morphine milligram equivalents (MMEs) prescribed for postoperative pain management, while secondary endpoints were emergency department (ED) visits and readmissions within 7 days of surgery. RESULTS: In a survey of breast surgeons, 23% reported using NORs in 2017 versus 79% in 2019 (p < 0.001). Comparing 1917 breast operations from 2016 with 2166 operations from 2019, NORs increased from 9% in 2016 to 39% in 2019 (p < 0.001). Average discharge MMEs per operation decreased from 190 in 2016 to 106 in 2019 (p < 0.001). NOR failure (defined as an additional opioid prescription within 2 weeks of surgery) was < 1%. Significantly fewer postoperative ED visits occurred in the NOR group (1.9% NOR vs. 3.4% opioid regimen [OR]; p < 0.001). The 7-day readmission rates for NOR and OR patients were similar (0.49% NOR vs. 0.32% OR; p = 0.45). CONCLUSION: Between 2016 and 2019, breast surgeons in a large, integrated health care delivery system adopted NORs for nearly 40% of breast operations, and prescribed significantly fewer MMEs, with no increases in ED visits or readmissions for NOR patients. This suggests that initiatives to decrease opioid prescribing were successful and that a NOR for pain management after breast surgery is feasible.
BACKGROUND: Postoperative prescriptions have contributed to the opioid epidemic. In response, a large, integrated health care delivery system implemented initiatives to reduce outpatient opioid prescriptions. We evaluated the impact of these interventions on opioid-prescribing practices after breast surgery. METHODS: We examined postoperative prescribing practices before and after the 2016-2018 intervention period. Primary endpoints were the use of non-opioid regimens (NORs) and morphine milligram equivalents (MMEs) prescribed for postoperative pain management, while secondary endpoints were emergency department (ED) visits and readmissions within 7 days of surgery. RESULTS: In a survey of breast surgeons, 23% reported using NORs in 2017 versus 79% in 2019 (p < 0.001). Comparing 1917 breast operations from 2016 with 2166 operations from 2019, NORs increased from 9% in 2016 to 39% in 2019 (p < 0.001). Average discharge MMEs per operation decreased from 190 in 2016 to 106 in 2019 (p < 0.001). NOR failure (defined as an additional opioid prescription within 2 weeks of surgery) was < 1%. Significantly fewer postoperative ED visits occurred in the NOR group (1.9% NOR vs. 3.4% opioid regimen [OR]; p < 0.001). The 7-day readmission rates for NOR and OR patients were similar (0.49% NOR vs. 0.32% OR; p = 0.45). CONCLUSION: Between 2016 and 2019, breast surgeons in a large, integrated health care delivery system adopted NORs for nearly 40% of breast operations, and prescribed significantly fewer MMEs, with no increases in ED visits or readmissions for NOR patients. This suggests that initiatives to decrease opioid prescribing were successful and that a NOR for pain management after breast surgery is feasible.
Authors: Annie Tang; Elad Neeman; Brooke Vuong; Vignesh A Arasu; Raymond Liu; Gillian E Kuehner; Alison C Savitz; Liisa L Lyon; Prachi Anshu; Samantha A Seaward; Milan D Patel; Laurel A Habel; Lawrence H Kushi; Margaret Mentakis; Eva S Thomas; Tatjana Kolevska; Sharon B Chang Journal: Breast Cancer Res Treat Date: 2022-01-06 Impact factor: 4.624
Authors: Jeffery M Chakedis; Annie Tang; Gillian E Kuehner; Brooke Vuong; Liisa L Lyon; Lucinda A Romero; Benjamin M Raber; Melinda M Mortenson; Veronica C Shim; Nicole M Datrice-Hill; Jennifer R McEvoy; Vignesh A Arasu; Dorota J Wisner; Sharon B Chang Journal: Ann Surg Oncol Date: 2021-08-26 Impact factor: 5.344
Authors: Kate R Pawloski; Regina Matar; Varadan Sevilimedu; Audree B Tadros; Laurie J Kirstein; Hiram S Cody; Kimberly J Van Zee; Monica Morrow; Tracy-Ann Moo Journal: Ann Surg Oncol Date: 2021-07-10 Impact factor: 5.344