Preventing Excess Narcotic Prescriptions in New Robotic Surgery Discharges: The PENN Prospective Cohort Quality Improvement Initiative

Talwar, Ruchika; Xia, Leilei; Serna, Juan Carlos Morales; Ding, James; Lee, Daniel J; Ziemba, Justin; Guzzo, Thomas J.

doi:10.1089/end.2019.0362

Cited by 24 publications

(13 citation statements)

References 10 publications

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“…We chose to examine prostatectomy and nephrectomy for a few reasons. First, they are common urologic surgeries that historically have required opioids postoperatively 7 . Second, we had previously demonstrated that the quantity of opioids patients consumed after these surgeries was significantly less than the quantity used 8 .…”

Section: Methodsmentioning

confidence: 99%

Large reduction in opioid prescribing by a multipronged behavioral intervention after major urologic surgery

Jacobs

Rogers

Yabes

et al. 2020

Cancer

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BackgroundSurgeons play a pivotal role in combating the opioid crisis that currently grips the United States. Changing surgeon behavior is difficult, and the degree to which behavioral science can steer surgeons toward decreased opioid prescribing is unclear.MethodsThis was a single‐institution, single‐arm, pre‐ and postintervention study examining the prescribing of opioids by urologists for adult patients undergoing prostatectomy or nephrectomy. The primary outcome was the quantity of opioids prescribed in oral morphine equivalents (OMEs) after hospital discharge. The primary exposure was a multipronged behavioral intervention designed to decrease opioid prescribing. The intervention had 3 components: 1) formal education, 2) individual audit feedback, and 3) peer comparison performance feedback. There were 3 phases to the study: a pre‐intervention phase, an intervention phase, and a washout phase.ResultsThree hundred eighty‐two patients underwent prostatectomy, and 306 patients underwent nephrectomy. The median OMEs decreased from 195 to 19 in the prostatectomy patients and from 200 to 0 in the nephrectomy patients (P < .05 for both). The median OMEs prescribed did not increase during the washout phase. Prostatectomy patients discharged with opioids had higher levels of anxiety than patients discharged without opioids (P < .05). Otherwise, prostatectomy and nephrectomy patients discharged with and without opioids did not differ in their perception of postoperative pain management, activity levels, psychiatric symptoms, or somatic symptoms (P > .05 for all).ConclusionsImplementing a multipronged behavioral intervention significantly reduced opioid prescribing for patients undergoing prostatectomy or nephrectomy without compromising patient‐reported outcomes.

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Section: Methodsmentioning

confidence: 99%

Large reduction in opioid prescribing by a multipronged behavioral intervention after major urologic surgery

Jacobs

Rogers

Yabes

et al. 2020

Cancer

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“…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%

“…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. All studies were either case-control or cohort studies, and there were no reports from randomized controlled trials.…”

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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“…Based on these findings, we were able to confidently and successfully transition to a non-opioid, MMA regimen. Moreover, current literature further supports the benefits and efficacy of non-opioid MMA protocols, preoperative analgesia, and nerve blocks to reduce post-operative pain and narcotic use in other urologic procedures both in the adult and pediatric population (11)(12)(13)(14).…”

Section: Editorialmentioning

confidence: 85%

Postoperative pain control after urethroplasty: an opportunity for non-opioid pain management

Leong¹,

Kommareddy²,

Chung³

2022

Transl Androl Urol

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Preventing Excess Narcotic Prescriptions in New Robotic Surgery Discharges: The PENN Prospective Cohort Quality Improvement Initiative

Cited by 24 publications

References 10 publications

Large reduction in opioid prescribing by a multipronged behavioral intervention after major urologic surgery

Large reduction in opioid prescribing by a multipronged behavioral intervention after major urologic surgery

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

Postoperative pain control after urethroplasty: an opportunity for non-opioid pain management

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