TY - JOUR
T1 - Evaluation of a tiered opioid prescription algorithm in an ERAS pathway
T2 - Exploring opportunities for further refinement
AU - Basabe, M. Sol
AU - Suki, Tina S.
AU - Munsell, Mark F.
AU - Iniesta, Maria D.
AU - Garcia Lopez, Juan E.
AU - Hillman, Robert Tyler
AU - Cain, Katherine
AU - Huepenbecker, Sarah
AU - Mena, Gabriel
AU - Taylor, Jolyn S.
AU - Ramirez, Pedro T.
AU - Meyer, Larissa A.
N1 - Publisher Copyright:
© IGCS and ESGO 2024. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2024/2/5
Y1 - 2024/2/5
N2 - Background Opioid over-prescription is wasteful and contributes to the opioid crisis. We implemented a personalized tiered discharge opioid protocol and education on opioid disposal to minimize over-prescription. Objective To evaluate the intervention by investigating opioid use post-discharge for women undergoing abdomino-pelvic surgery, and patient adherence to opioid disposal education. Methods We analyzed post-discharge opioid consumption among 558 patients. Eligible patients included those who underwent elective gynecologic surgery, were not taking scheduled opioids pre-operatively, and received discharge opioids according to a tiered prescribing algorithm. A survey assessing discharge opioid consumption and disposal safety knowledge was distributed on post-discharge day 21. Over-prescription was defined as >20% of the original prescription left over. Descriptive statistics were used for analysis. Results The survey response rate was 61% and 59% in the minimally invasive surgery and open surgery cohorts, respectively. Overall, 42.8% of patients reported using no opioids after hospital discharge, 45.2% in the minimally invasive surgery and 38.6% in the open surgery cohort. Furthermore, 74.9% of respondents were over-prescribed, with median age being statistically significant for this group (p=0.004). Finally, 46.4% of respondents expressed no knowledge regarding safe disposal practices, with no statistically significant difference between groups (p>0.99). Conclusion Despite implementation of the tiered discharge opioid algorithm aimed to personalize opioid prescriptions to estimated need, we still over-prescribed opioids. Additionally, despite targeted education, nearly half of all patients who completed the survey did not know how to dispose of their opioid tablets. Additional efforts are needed to further refine the algorithm to reduce over-prescription of opioids and improve disposal education.
AB - Background Opioid over-prescription is wasteful and contributes to the opioid crisis. We implemented a personalized tiered discharge opioid protocol and education on opioid disposal to minimize over-prescription. Objective To evaluate the intervention by investigating opioid use post-discharge for women undergoing abdomino-pelvic surgery, and patient adherence to opioid disposal education. Methods We analyzed post-discharge opioid consumption among 558 patients. Eligible patients included those who underwent elective gynecologic surgery, were not taking scheduled opioids pre-operatively, and received discharge opioids according to a tiered prescribing algorithm. A survey assessing discharge opioid consumption and disposal safety knowledge was distributed on post-discharge day 21. Over-prescription was defined as >20% of the original prescription left over. Descriptive statistics were used for analysis. Results The survey response rate was 61% and 59% in the minimally invasive surgery and open surgery cohorts, respectively. Overall, 42.8% of patients reported using no opioids after hospital discharge, 45.2% in the minimally invasive surgery and 38.6% in the open surgery cohort. Furthermore, 74.9% of respondents were over-prescribed, with median age being statistically significant for this group (p=0.004). Finally, 46.4% of respondents expressed no knowledge regarding safe disposal practices, with no statistically significant difference between groups (p>0.99). Conclusion Despite implementation of the tiered discharge opioid algorithm aimed to personalize opioid prescriptions to estimated need, we still over-prescribed opioids. Additionally, despite targeted education, nearly half of all patients who completed the survey did not know how to dispose of their opioid tablets. Additional efforts are needed to further refine the algorithm to reduce over-prescription of opioids and improve disposal education.
KW - Gynecologic Surgical Procedures
KW - Opioid-Related Disorders
KW - Pain
KW - Postoperative Period
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UR - http://www.scopus.com/inward/citedby.url?scp=85201987106&partnerID=8YFLogxK
U2 - 10.1136/ijgc-2023-004948
DO - 10.1136/ijgc-2023-004948
M3 - Article
C2 - 38123191
AN - SCOPUS:85201987106
SN - 1048-891X
VL - 34
SP - 251
EP - 259
JO - International Journal of Gynecological Cancer
JF - International Journal of Gynecological Cancer
IS - 2
ER -