Keeping tabs: Reducing postoperative opioid prescriptions for patients after breast surgical procedures

Gunasingha, Rathnayaka M K D; Niloy, Injamamul L; Wetstein, Berish B.; Learn, Peter A.; Turza, Lauren C.

doi:10.1016/j.surg.2020.11.045

Cited by 4 publications

(3 citation statements)

References 27 publications

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“…Another limitation of the present study was the use of opioid and non-opioid medications as the primary outcome variables (rather than measures of participation). While this is consistent with previous studies (Copeland-Halperin et al, 2019;Gunasingha et al, 2021;Samuel et al, 2022), this approach limited our ability to interpret mechanisms underlying the outcomes we found. We feel that further research is needed that goes beyond the need of opioids (or non-opioids), and even the intensity of pain and rather focus on measures of occupational participation and independence.…”

Section: Study Limitationssupporting

confidence: 90%

Occupational Therapy After Breast Cancer Reconstructive Surgery: A Predictor for Opioid Prescriptions

Steuer

Polo

Little

et al. 2023

OTJR: Occupational Therapy Journal of Research

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Occupational therapy practitioners have a unique and vital role among interprofessional health care teams toward facilitating occupational participation among breast cancer survivors. This study investigated the relationship between acute medicine occupational therapy services after breast cancer reconstructive surgeries (BCRS) and a number of prescription refills 90 days after surgery. This retrospective study ran binary logistic regression analyses on 562 women after BCRS for refills of opioid and non-opioid medication. Both models were statistically significant, χ2(7df) = 23.001, p = .002; χ2(7df) = 32.312, p < .001, indicating the ability to distinguish who received opioid or non-opioid refills, respectively. While younger age was a significant predictor across both models, occupational therapy was only significant for opioid refills; each was associated with fewer refills. Early occupational therapy treatment after BCRS is associated with fewer opioid prescriptions 90 days after surgery, therefore enhancing occupation throughout this timeframe is beneficial.

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Section: Study Limitationssupporting

confidence: 90%

Occupational Therapy After Breast Cancer Reconstructive Surgery: A Predictor for Opioid Prescriptions

Steuer

Polo

Little

et al. 2023

OTJR: Occupational Therapy Journal of Research

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“…Despite high awareness of the opioid epidemic, clinicians still overprescribe opioids after surgery. [1][2][3][4][5][6][7] This postoperative overprescribing puts both patients and communities at risk, increasing the patient's likelihood of developing chronic opioid use [8][9][10][11][12][13][14] or opioidinduced ventilatory impairment 11 and adding to the reservoir of unused opioids available for misuse and diversion. 11 15 The discrepancy between clinicians' awareness of the opioid epidemic and the degree of overprescribing-over half of opioid pills prescribed after surgery go unused 7 suggests that prescribing practices are not based on purely rational decisions.…”

Section: Introduction Backgroundmentioning

confidence: 99%

“…Despite high awareness of the opioid epidemic, clinicians still overprescribe opioids after surgery 1–7. This postoperative overprescribing puts both patients and communities at risk, increasing the patient’s likelihood of developing chronic opioid use8–14 or opioid-induced ventilatory impairment11 and adding to the reservoir of unused opioids available for misuse and diversion 11 15…”

Section: Introductionmentioning

confidence: 99%

Evaluating the effectiveness of email-based nudges to reduce postoperative opioid prescribing: study protocol of a randomised controlled trial

et al. 2022

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IntroductionSurgical patients are commonly prescribed more opioids at discharge than needed to manage their postoperative pain. These excess opioids increase the risks of new persistent opioid use, opioid-induced ventilatory impairment and opioid diversion. This study tests the effectiveness of two behavioural nudges, one based on peer behaviour and one based on best practice guidelines, in reducing excessive postoperative opioid prescriptions.Methods and analysisThe study will be conducted at 19 hospitals within a large healthcare delivery system in northern California, USA. Three surgical specialties (general surgery, orthopaedic surgery and obstetric/gynaecological surgery) at each hospital will be randomised either to a control group or to one of two active intervention arms. One intervention is grounded in the theory of injunctive norms, and provides feedback to surgeons on their postoperative opioid prescribing relative to prescribing guidelines endorsed by their institution. The other intervention draws from the theory of descriptive norms, and provides feedback similar to the first intervention but using peers’ behaviour rather than guidelines as the benchmark for the surgeon’s prescribing behaviour. The interventions will be delivered by a monthly email. Both interventions will be active for twelve months. The effects of each intervention relative to the control group and to each other will be tested using a four-level hierarchical model adjusted for multiple hypothesis testing.Ethics and disseminationUsing behavioural nudges rather than rigid policy changes allows us to target excessive prescribing without preventing clinicians from using their clinical judgement to address patient pain. All study activities have been approved by the RAND Human Subjects Protection Committee (ID 2018-0988). Findings will be disseminated through conference presentations, peer-reviewed publications and social media accounts.Trial registration numberNCT05070338.

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The prevalence and predictors of discharge opioid overprescribing in opioid-naïve patients after breast, gynecologic, and head and neck cancer surgery: a prospective cohort study

Lee,

Siddiqui,

Heller

et al. 2024

Can J Anesth/J Can Anesth

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Keeping tabs: Reducing postoperative opioid prescriptions for patients after breast surgical procedures

Cited by 4 publications

References 27 publications

Occupational Therapy After Breast Cancer Reconstructive Surgery: A Predictor for Opioid Prescriptions

Occupational Therapy After Breast Cancer Reconstructive Surgery: A Predictor for Opioid Prescriptions

Evaluating the effectiveness of email-based nudges to reduce postoperative opioid prescribing: study protocol of a randomised controlled trial

The prevalence and predictors of discharge opioid overprescribing in opioid-naïve patients after breast, gynecologic, and head and neck cancer surgery: a prospective cohort study

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