Transitions of Care for Postoperative Opioid Prescribing in Previously Opioid-Naïve Patients in the USA: a Retrospective Review

Klueh, Michael P; Hu, Hsou Mei; Howard, Ryan; Vu, Joceline V.; Harbaugh, Calista M.; Lagisetty, Pooja; Brummett, Chad M.; Englesbe, Michael J.; Waljee, Jennifer F.; Lee, Jay S.

doi:10.1007/s11606-018-4463-1

Cited by 44 publications

(42 citation statements)

References 32 publications

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“…Another limitation was that the intervention was limited to surgeons only. Unfortunately, patients with cancer are frequently exposed to uncoordinated opioid prescribing from multiple specialties 14 , 34 . Future work will focus on facilitating more effective transitions of care for surgical patients to prevent uncoordinated opioid prescribing.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Education and Prescribing Guidelines on Opioid Prescribing for Breast and Melanoma Procedures

et al. 2018

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BACKGROUND: Excessive opioid prescribing is common in surgical oncology with 72% of prescribed opioids going unused after curative-intent surgery. In this study, we sought to reduce opioid prescribing after breast and melanoma procedures by designing and implementing an intervention focused on education and prescribing guidelines. We then evaluated the impact of this intervention. METHODS: In this single-institution study, we designed and implemented an intervention targeting key factors identified in qualitative interviews. This included mandatory education for prescribers, evidence-based prescribing guidelines, and standardized patient instructions. After the intervention, interrupted time series analysis was used to compare the mean quantity of opioid prescribed before and after the intervention (July 2016-September 2017). We also evaluated the frequency of opioid prescription refills. RESULTS: During the study, 847 patients underwent breast or melanoma procedures and received an opioid prescription. For mastectomy or wide local excision for melanoma, the mean quantity of opioid prescribed immediately decreased by 37% after the intervention (P=0.03), equivalent to 13 tablets of 5mg oxycodone. For lumpectomy or breast biopsy, the mean quantity of opioid prescribed decreased by 42% or 12 tablets of 5mg oxycodone (P=0.07). Furthermore, opioid prescription refills did not significantly change for mastectomy/wide local excision (13% vs. 14%, P=0.8), or lumpectomy/breast biopsy (4% vs. 5%, P=0.7). CONCLUSIONS: Education and prescribing guidelines reduced opioid prescribing for breast and melanoma procedures without increasing the need for refills. This suggests further reductions in opioid prescribing may be possible, and provides rationale for implementing similar interventions for other procedures and practice settings.

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Section: Discussionmentioning

confidence: 99%

The Impact of Education and Prescribing Guidelines on Opioid Prescribing for Breast and Melanoma Procedures

et al. 2018

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“…As used in prior studies, 13,[16][17][18]20,21 opioid prescriptions were attributed to surgery (eg, perioperative) if filled between 30 days before surgery and 14 days after discharge. Patients were defined as opioid-naive if no opioid prescriptions were filled between 12 months and 31 days before surgery, also consistent with prior work.…”

Section: Opioid Definitionsmentioning

confidence: 99%

“…New persistent opioid use was defined as an initial perioperative opioid prescription fill, followed by one or more subsequent opioid prescription fills 91 to 180 days after the date of surgery. This definition has been used in prior analyses 13,14,17,18,20 and captures a period during which recovery from surgery is expected to have occurred.…”

Section: Opioid Definitionsmentioning

confidence: 99%

Impact of Prescribing on New Persistent Opioid Use After Cardiothoracic Surgery

Brescia

Waljee

et al. 2019

The Annals of Thoracic Surgery

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Background. New persistent opioid use occurs in 3% to 14% of patients after elective surgery, but is poorly described after cardiothoracic surgery. We examined the association of prescription size with new persistent opioid use after cardiothoracic surgery. Methods. Opioid-naive Medicare patients undergoing cardiothoracic surgery between 2009 and 2015 were identified. Patients who filled an opioid prescription between 30 days before surgery and 14 days after discharge and with continuous Medicare enrollment 12 months before and 6 months after surgery were selected (n [ 24,549). New persistent use was defined as continued prescription fills 91 to 180 days after surgery. Prescription size was reported in oral morphine equivalents. Multivariable regression was performed for risk adjustment, and new persistent use rate was estimated. Results. Patient age was 71 ± 8 years, 9222 (38%) were female, and 20,898 (85%) were white. Overall new persistent use was 12.8% (3153 of 24,549), and declined yearly from 17% in 2009 to 7.1% in 2015 (P < .001). Prescription size, preoperative prescription fills, black race, gastrointestinal complications, disability status, open lung resection, dual eligibility (Medicare and Medicaid), drug and substance abuse, female sex, tobacco use, high comorbidity, pain disorders, longer hospital stay, and younger age were associated with new persistent use. Adjusted new persistent use was 19.6% (95% confidence interval, 18.7% to 20.4%) among patients prescribed more than 450 oral morphine equivalents, compared with 10.4% (95% confidence interval, 9.9% to 10.8%) among those prescribed 200 oral morphine equivalents or less (P < .001). Conclusions. Size and timing of perioperative opioid prescriptions were the strongest predictors of new persistent opioid use after cardiothoracic surgery. Modifiable risk factors such as prescription size should be targeted to reduce new persistent use.

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“…There has been much reporting on opioid prescribing, use, and abuse throughout the decades [4,[12][13][14].…”

Section: Discussionmentioning

confidence: 99%

Opioid Prescribing Practices and Quality Improvements Within an Outpatient Orthopedic Practice

Nouraee¹,

Uzlik²,

Wyard³

et al. 2021

Cureus

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BackgroundDuring the last several decades, the opioid epidemic throughout the United States has been recognized as an increasing problem. The aim of this study was to identify and implement processes throughout a single private orthopedic practice and managed ambulatory surgery centers to reduce opioid prescription pill quantity and strength, while also reducing consumption. MethodologyA baseline assessment along with the development of four separate phases was implemented. Data collection included type, dosage, and quantity of opioids prescribed after elective outpatient procedures as well as patient interviews/surveys within two weeks after surgery. Quality improvement implementation included: (a) presentations on opioid prescribing at an individual physician level, (b) internal prescription guidelines, (c) required Prescription Monitoring Program registration, and (d) patient narcotic education pamphlets after surgery. The average opioids prescribed and consumed were compared between different time points. ResultsAnalysis revealed a highly statistically significant decrease in both pills and morphine equivalent units (MEUs) prescribed (p < 0.001, p < 0.001) between the baseline assessment and four subsequent phases, as well as consumed (p < 0.001, p < 0.001) between phases one through four. Even though patients were consuming less pills and MEUs than they were prescribed on average across all phases, overall pain levels increased between phases one through four (p < 0.001), and overall satisfaction of pain control decreased between phases two through four (p < 0.001). ConclusionsOver a 24-month time frame, a single private orthopedic practice set a goal of reducing prescribing habits and with successful implementation of various measures, a significant reduction in opioids prescribed and consumed was accomplished. Interestingly, pain level and satisfaction of pain control worsened even though patients were continuing to be prescribed more opioids on average than they were consuming. Therefore, it may be normal to see these results when attempting to set the expectation for some level of pain and reduced consumption of opioid medications post-operatively. Overall, these results can be useful to healthcare administrators and surgeons looking for ways to combat the opioid epidemic.

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Transitions of Care for Postoperative Opioid Prescribing in Previously Opioid-Naïve Patients in the USA: a Retrospective Review

Cited by 44 publications

References 32 publications

The Impact of Education and Prescribing Guidelines on Opioid Prescribing for Breast and Melanoma Procedures

The Impact of Education and Prescribing Guidelines on Opioid Prescribing for Breast and Melanoma Procedures

Impact of Prescribing on New Persistent Opioid Use After Cardiothoracic Surgery

Opioid Prescribing Practices and Quality Improvements Within an Outpatient Orthopedic Practice

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