Description and Impact of a Comprehensive Multispecialty Multidisciplinary Intervention to Decrease Opioid Prescribing in Surgery

Kaafarani, Haytham M.A.; Eid, Ahmed; Antonelli, Donna; Chang, David C.; Elsharkawy, Ahmed E.; Elahad, Joana Abed; Lancaster, Elizabeth A; Schulz, John; Melnitchouk, Serguei; Kastrinakis, William V.; Hutter, Matthew M.; Masiakos, Peter T.; Colwell, Amy S.; Wright, Cameron D.; Lillemoe, Keith D.

doi:10.1097/sla.0000000000003462

Cited by 70 publications

(46 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Provider education and implementing procedure-specific prescribing guidelines for discharge have consistently been shown to reduce new persistent opioid use [18,[31][32][33][34]. In a study by Kaafarni et al (2019), persistent postoperative opioid use was decreased after implementation of a multidisciplinary intervention including opioid guidelines for procedures from 11 different specialties, provider-focused posters displayed in all surgical units, patient opioid/pain brochures setting expectations, and educational seminars to residents, advanced practice providers, and nurses [35]. Similarly, a 2020 study by Patel et al found that implementing an opioid reduction intervention consisting of an informational sheet for patients at discharge, education by nurses at discharge, and an evidence-based prescribing guideline resulted in decreased opioid usage in the first 30 days after surgery [36].…”

Section: Postoperative Interventionsmentioning

confidence: 99%

Reducing New Persistent Opioid Use After Surgery: A Review of Interventions

Burns

Urman

Pian

et al. 2021

Curr Pain Headache Rep

View full text Add to dashboard Cite

Purpose of Review This review aims to summarize interventions used in the perioperative period to reduce the development of new persistent postoperative opioid use in opioid-naïve patients. Recent Findings The development of new persistent opioid use after surgery has recently been identified as a common postoperative complication. The existing literature suggests that interventions across the continuum of care have been shown to decrease the incidence of new persistent postoperative opioid use. Specific preoperative, intraoperative, and postoperative interventions will be reviewed, as well as the use of clinical pathways and protocols that span throughout the perioperative period. Common to many of these interventions include the use of multimodal analgesia throughout the perioperative period and an emphasis on a patient-centered, evidence-based approach to the perioperative pain management plan. Summary While the incidence of new persistent postoperative opioid use appears to be high, the literature suggests that there are both small- and large-scale interventions that can be used to reduce this. Technological advances including prescription monitoring systems and mobile applications have enabled studies to monitor opioid consumption after discharge. Interventions that occur preoperatively, such as patient education and expectation setting regarding postoperative pain management, and interventions that occur postoperatively, such as the implementation of procedure-specific, evidence-based prescribing guidelines and protocols, have been shown to reduce post-discharge opioid consumption. The use of multimodal analgesia and opioid-sparing adjuncts throughout the perioperative period is central to many of these interventions and has essentially become standard of care for management of perioperative pain.

show abstract

Section: Postoperative Interventionsmentioning

confidence: 99%

Reducing New Persistent Opioid Use After Surgery: A Review of Interventions

Burns

Urman

Pian

et al. 2021

Curr Pain Headache Rep

View full text Add to dashboard Cite

show abstract

“…Other studies interested in postoperative opioid prescription volume have gathered data by liking pharmacy platforms and retrospectively gathering prescription data. 10,12,13 If these methods are not feasible, utilizing custom variable creation in ACS-NSQIP to gather prescription data is beneficial due to its prospective nature and ease of coordinating collection across a multi-institutional setting. As described, this method allows hospitals to review data collected during a sample period, which can lead hospitals to implement changes on custom variables to increase the quality of data collected for analysis.…”

Section: Discussionmentioning

confidence: 99%

Georgia Quality Improvement Programs Multi-Institutional Collection of Postoperative Opioid Data Using ACS-NSQIP Abstraction

Codner

Falconer

Ashley

et al. 2022

The American Surgeon

View full text Add to dashboard Cite

Background Excessive postoperative opioid prescribing contributes to opioid misuse throughout the US. The Georgia Quality Improvement Program (GQIP) is a collaboration of ACS-NSQIP participating hospitals. GQIP aimed to develop a multi-institutional opioid data collection platform as well as understand our current opioid-sparing strategy (OSS) usage and postoperative opioid prescribing patterns. Methods This study was initiated 7/2019, when 4 custom NSQIP variables were developed to capture OSS usage and postoperative opioid oral morphine equivalents (OMEs). After pilot collection, our discharge opioid variable required optimization for adequate data capture and was expanded from a free text option to 4 drop-down selection variables. Data collection then continued from 2/2020-5/2021. Logistic regression was used to determine associations with OSS usage. Average OMEs were calculated for common general surgery procedures and compared to national guidelines. Results After variable optimization, the percentage where a total discharge prescription OME could be calculated increased from 26% to 70% ( P < .001). The study included 820 patients over 10 operations. There was a significant variation in OSS usage between GQIP centers. Laparoscopic cases had higher odds of OSS use (1.92 (1.38-2.66)) while OSS use had lower odds in black patients on univariate analysis (.69 (.51-.94)). On average 7 out of the 10 cases had higher OMEs prescribed compared to national guidelines recommendations. Conclusion Developing a multi-institutional opioid data collection platform through ACS-NSQIP is feasible. Preselected drop-down boxes outperform free text variables. GQIP future quality improvement targets include variation in OSS use and opioid overprescribing.

show abstract

“…Adding simple educational sessions that encourage the judicious prescription of opioids has been shown to decrease the amount of opioids prescribed by residents. 18,23 Coupling this education with system-wide changes, such as setting the default number of pills a provider orders through the electronic medical record to a lower number 20,24 or system-wide guideline development with educational programs aimed at all tiers of providers, 25,26 has also been shown to produce a durable reduction in the amount of OME prescribed while also not increasing the number of refills requested by patients.…”

Section: Discussionmentioning

confidence: 99%