Prospective Evaluation of a Tiered Opioid Prescribing Guideline for Inpatient Colorectal Operations.

Abstract

OBJECTIVE\nThis study sought to prospectively validate an institutional prescribing guideline based on previously defined opioid consumption patterns following inpatient colorectal operations.\n\n\nBACKGROUND\nIn light of the opioid epidemic, reducing excess prescription quantities is key while still tailoring to patient needs.\n\n\nMETHODS\nThis is a cohort study of elective colorectal operations (colectomies, proctectomies, and ostomy reversals) at a single tertiary care medical center. Opioid prescribing and consumption patterns (quantified as Equianalgesic 5\u200amg Oxycodone Pills, EOP) were compared before and after adoption of a tiered opioid prescribing guideline. Tiers were divided based on opioid consumption in the 24-hours prior to discharge: Tier 1 (0 EOP), Tier 2 (0.1-3 EOP), and Tier 3 (>3 EOP). Our guideline recommended maximum prescriptions of 0 EOP for Tier 1, 12 EOP for Tier 2, and 30 EOP for Tier 3.\n\n\nRESULTS\nThe study included 100 patients before and 101 after guideline adoption. Demographic and operative characteristics were similar between cohorts. Guideline adherence was 85%. Overall, there was a 41% reduction in mean prescription quantity and 53% reduction in excess pills per prescription. No change in opioid consumption or refill rates was observed.\n\n\nCONCLUSION\nAdoption of a tiered opioid prescribing guideline significantly reduced opioid prescription quantity with no change in consumption or refill rates. Standardization of discharge prescriptions based on patient consumption in the 24-hours prior to discharge may be an important step towards minimizing excess prescribing.