Implementing a Protocol to Reduce Opioid Prescriptions in Military Otolaryngology: A Quality Improvement Initiative

Abstract

Introduction To compare pain medication refill rates for adult septoplasty and rhinoplasty patients before and after initiating a multimodal analgesic protocol for reducing opioid prescriptions (PROP). Materials and Methods Data from 58 adult patients were retrieved by retrospective chart review (19 septoplasties and 10 rhinoplasties before initiating PROP in September 2018 and 21 septoplasties and 8 rhinoplasties after PROP). We selected consecutive septoplasties and rhinoplasties, at which time a new discharge order set was implemented. The new order set consisted of 10 oxycodone tabs (5 mg), 100 acetaminophen tabs (325 mg), and 28 celecoxib tabs (200 mg). The primary outcome variable was the number of initial opioid prescriptions and refills filled by any provider. Results Among the septoplasties, there was a 46% decrease in total morphine milligram equivalent (MME) prescribed, from a mean of 202.0 mg in the non-PROP group (95% CI, 235.4, 174.6) to 108.6 mg in the PROP group (95% CI, 135.8, 81.4), with no difference in refill rates. Among the rhinoplasties, there was a 51% decrease in total MME prescribed, from a mean of 258.8 mg in the non-PROP group (95% CI, 333.4, 184.1) to 126.6 mg in the PROP group (95% CI, 168.1, 85.0) with no difference in refill rates. Conclusions The outcomes after PROP implementation for septoplasty and rhinoplasty at our institution suggest that opioid prescription rates can be significantly decreased to manage postoperative pain, with no difference in opioid refill rates. The results also warrant further investigation into patient pain, satisfaction, provider efficiency, and healthcare costs.

Opioid-Sparing Pain Control after Rhinoplasty: Updated Review of the Literature

“…Use of celecoxib led to decreased opioid use, with groups reporting up to a 76% decrease in oral morphine equivalents. 23,28 Notably, patients who received celecoxib had significantly lower rates of postoperative nausea and vomiting compared to patients who did not receive celecoxib, likely secondary to decreased opioid consumption. 28…”

“…[13][14][15] Common opioids prescribed include tramadol, oxycodone, hydrocodone-acetaminophen, and oxycodone-acetaminophen with the number of tablets ranging from 10 to 40 tablets. [3][4][5][6][7][9][10][11][15][16][17][18][19][20][21][22][23][24][25][26] Patient-reported opioid use after rhinoplasty starkly contrasts the liberal prescription of opioids by providers. Patients routinely report taking < 50% of opioids that they are prescribed with several studies concluding that a postoperative prescription of 15 tablets provides sufficient pain control for 90% of patients.…”