Impact of a tiered discharge opioid algorithm on prescriptions and patient-reported outcomes after open gynecologic surgery

Sarah Huepenbecker, Robert Tyler Hillman, Maria D. Iniesta, Tsun Chen, Katherine Cain, Gabriel Mena, Javier Lasala, Xin Shelley Wang, Loretta Williams, Jolyn S. Taylor, Karen H. Lu, Pedro T. Ramirez, Larissa A. Meyer

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Objective To compare discharge opioid refills, prescribed morphine equivalent dose and quantity, and longitudinal patient-reported outcomes before and after implementation of a tiered opioid prescribing algorithm among women undergoing open gynecologic surgery within an enhanced recovery after surgery program. Methods We compared opioid prescriptions, clinical outcomes, and patient-reported outcomes among 273 women. Post-discharge symptom burden was collected up to 42 days after discharge using the validated 27-item MD Anderson Symptom Inventory and analyzed using linear mixed effects models and Kaplan-Meier curves for symptom recovery. Results Among 113 pre-implementation and 160 post-implementation patients there was no difference in opioid refills (9.7% vs 11.3%, p=0.84). The post-implementation cohort had a significant reduction in median morphine equivalent dose (112.5 mg vs 225 mg, p<0.01), with no difference in median hospital length of stay (3 days vs 3 days, p=1.0) or 30-day readmission rate (9.4% vs 7.1%, p=0.66). There was no difference in patient-reported pain between the pre- and post-implementation cohorts on the day of discharge (severity 4.93 vs 5.14, p=0.53) or in any patient-reported symptoms, interference measures, or composite scores by post-discharge day 7. The median recovery time for most symptoms was 7 days, except for pain (14 days), fatigue (18 days), and physical interference (21 days), with no differences between cohorts. Conclusions After implementation of a tiered opioid prescribing algorithm, the quantity and dose of discharge opioids prescribed decreased with no change in post-operative refills and without negatively impacting patient-reported symptom burden or interference, which can be used to educate and reassure patients and providers.

Original languageEnglish (US)
Pages (from-to)1052-1060
Number of pages9
JournalInternational Journal of Gynecological Cancer
Issue number7
StatePublished - Jul 1 2021


  • gynecologic surgical procedures
  • opioid-related disorders
  • postoperative care

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynecology


Dive into the research topics of 'Impact of a tiered discharge opioid algorithm on prescriptions and patient-reported outcomes after open gynecologic surgery'. Together they form a unique fingerprint.

Cite this