Implementation of Postoperative Standard Opioid Prescribing Schedules Reduces Opioid Prescriptions Without Change in Patient-reported Pain Outcomes

Gessner, Kathryn H.; Jung, Jaehyuk; Cook, Hannah; Graves, John Lee; McNaull, Peggy; Chidgey, Brooke; Mann, Jami; Woody, Nathan; Deal, Allison M.; Coward, R. Matthew; Figler, Bradley D.; Borawski, Kristy M.; Bjurlin, Marc A.; Raynor, Mathew C.; Tan, Hung‐Jui; Viprakasit, Davis P.; Wallen, Eric; Nielsen, Matthew E.; Smith, Angela

doi:10.1016/j.urology.2020.11.009

Cited by 8 publications

(11 citation statements)

References 24 publications

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“…Nineteen studies (8,407 patients; 4,443 in the pre- and 4,031 in the post-intervention cohort) reported sufficient data on prescribed opioids in both cohorts to allow for pooled analysis. 10–25,28,30–32 A significant reduction in prescribed opioids at discharge was noted in all except 1 study following the implementation of various interventions. The mean overall reduction in the post-intervention cohort was −67.59 MME (95% CI 54.23–80.94, p <0.001, I 2 =95%; fig.…”

Section: Resultsmentioning

confidence: 91%

“…Thirteen studies 11,12,14,15,18–23,25,28,31 (6,503 patients) reported the effectiveness of direct interventions and 6 studies 10,13,16,24,30,32 (1,815 patients) evaluated the effectiveness of indirect interventions. There was significant reduction in mean prescribed opioids following both the direct (−76.68 MME, 95% CI 60.04–93.31, p <0.001) and the indirect interventions (−46.72 MME, 95% CI 24.20–69.23, p <0.001).…”

Section: Resultsmentioning

confidence: 99%

“…Seven studies (1,872 patients) provided data on the use of prescribed opioids by the patients. 11,14,15,21,23,25,28 Five of the 7 studies demonstrated significant reductions in opioids used by patients, while the remaining 2 studies showed a nonsignificant reduction. 11,15,23,25,28 The mean overall reduction in the opioid used per patient was −18.31 MME (95% CI 7.89–28.72, p <0.0001; fig.…”

Section: Resultsmentioning

confidence: 99%

“…Four studies reported either the patient-reported pain score (489 patients) or satisfaction with pain control (279 patients) before and after the interventions 11,15,21,28 (supplementary figs. I and II, https://www.jurology.com).…”

Section: Resultsmentioning

confidence: 99%

“…Of the 8,904 patients from 22 studies used for the qualitative review, 4,560 patients were in the pre-intervention cohort and 4,251 patients in the post-intervention cohort. 10–32 Direct interventions to reduce opioid prescriptions were evaluated in 16 studies 11,12,14,15,18–21,25–29,31 (7,086 patients), while 6 studies 10,13,16,24,30,32 (1,818 patients) evaluated the effects of various indirect interventions. In 12 studies, 10,11,14,16,19,21,24–26,29,30,32 the procedures were categorized as major surgery, while 7 studies 12,13,18,20,22,23,27 included minor procedure and 3 studies 16,28,31 included both.…”

Section: Resultsmentioning

confidence: 99%

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Interventions to Reduce Opioid Prescriptions following Urological Surgery: A Systematic Review and Meta-Analysis

et al. 2022

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Purpose: Opioid prescriptions after surgery are major contributors to the opioid abuse epidemic. Several measures designed to limit opioid prescriptions at discharge have been evaluated. We conducted a comprehensive review and metaanalysis of the effectiveness of various types of interventions in reducing opioid prescriptions after urological surgery. Materials and Methods: A systematic review including MEDLINEÒ, Web of ScienceÔ and Cochrane databases was conducted to identify studies on opioid prescriptions and urological surgery. Twenty-two studies met the inclusion criteria, of which 19 were used for quantitative analysis for reduction in opioid prescriptions. Additional outcomes included opioid consumption and satisfaction with analgesia. Results: Of the 8,318 patients, 53% were in the pre-and 47% in the postintervention cohort. Overall mean reduction/patient in prescribed opioids was À67.59 (95% CI 54.23 to 80.94) morphine milligram equivalents (MME). Direct interventions, implemented by providers within their local department or hospital, were more effective in reducing prescribed opioids compared to indirect, or systemic, interventions, at À76.68 MME (95% CI 60.04 to À93.31) vs À46.72 MME (95% CI 24.20 to À69.23; p[0.04). Opioid consumption significantly decreased post-intervention with a mean reduction of -18.31 MME (95% CI 7.89 to 28.72). Patient satisfaction with analgesia remained unchanged between the pre-and post-intervention groups. Conclusions: Successful reduction in opioid prescriptions, without compromising pain control, can be achieved through a variety of interventions. Direct interventions appear to have a greater impact than indirect interventions in reducing opioid prescriptions. Despite the reduction, unused, excess prescription opioids were still noted, which provides an opportunity for further control on opioid prescriptions.

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Section: Resultsmentioning

confidence: 91%

Section: Resultsmentioning

confidence: 99%