Assessing the Impact of Procedure-Specific Opioid Prescribing Recommendations on Opioid Stewardship Following Pelvic Organ Prolapse Surgery.

Abstract

BACKGROUND\nNationally, there is increasing concern regarding the volume of opioid medications prescribed postoperatively and the rate of prescription opioid related adverse-events. In evaluation of this, several reports have identified significant variability in postoperative opioid prescribing patterns, including quantities exceeding patient s needs, especially after minor surgical procedures. However, data regarding patient s postoperative opioids needs following surgery for pelvic organ prolapse are sparse.\n\n\nOBJECTIVE\nTo design procedure-specific opioid prescribing recommendations for pelvic organ prolapse surgeries and evaluate their impact on opioid stewardship.\n\n\nSTUDY DESIGN\nWe prospectively evaluated opioid prescribing patterns, patient utilization, medication refills, and patient satisfaction in women undergoing prolapse surgery (i.e. vaginal, abdominal, or robotic) during an eight-month time-period. Two cohorts of women, stratified by whether they had surgery before or after implementation of procedure-specific opioid prescribing recommendations, were evaluated. Postoperative opioid usage (assessed via pill count), medication refills, and satisfaction with pain management after hospital dismissal were evaluated by telephone call two weeks after surgery. Postoperative opioid prescribing and use were recorded after conversion to Oral Morphine Equivalents (OME).\n\n\nRESULTS\nOverall, 96 women were included, 57 in the initial baseline cohort, and 39 following implementation of the prescribing recommendations. In the initial cohort, 32.8% of the prescribed OME (3607/11007 mg) were consumed. Following implementation of the prescribing recommendations, median OME prescribed decreased from 200 mg OME (IQR 150,225) to 112.5 mg OME (IQR 22.5,112.5; p <0.0001). The total OME prescribed decreased by 45% when compared with the volume that would have been prescribed before implementing the recommendations. The amount of leftover opioids per patient significantly decreased as well (p<0.0001). Pain medication refills increased after the intervention (18% vs 3.5%; p=0.03), while satisfaction scores were similar in both cohorts (p=0.87).\n\n\nCONCLUSIONS\nBy utilizing procedure-specific opioid prescribing recommendations we decreased the number of opioids prescribed at hospital dismissal by roughly half. Decreased opioid prescribing did not adversely impact patient satisfaction.