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Abstract
Discussion Forum (0)
Introduction: The study objective was to evaluate patient factors associated with post-operative opiate usage and to utilize these data to develop and assess specific recommendations for post-operative opiate prescribing.
Methods: We retrospectively reviewed patients under an IRB exempt protocol who were undergoing gynecologic surgery on an enhanced recovery pathway (ERAS) from 12/2018 to 5/2019 at a tertiary academic institution; patients with post-operative complications, chronic pain or opiate abuse were excluded. Opiate usage in the 24 hours prior to discharge was evaluated using multivariable regression to control for demographic information, procedure type, opiate requirement while admitted and pain scores. Discharge opiate prescription recommendations were subsequently developed based on patient opiate use and implemented in discharge order sets in 03/2020. Patients discharged following implementation were followed prospectively from 07/2020 to 09/2020 to assess for quantity of opiate prescribed and refill requests.
Results: There were 220 patient in the pre-intervention cohort and 120 patients post intervention. Actual patient opiate usage in the pre-intervention cohort correlated only with pain score and age (p < 0.001, p=0.04), not procedure type; however, opiate prescribed were predominately procedure based. A standardized recommendation for opiate prescription based on opiate usage in the 24 hours prior to discharge was added to the discharge order set. Post intervention, opiate prescriptions decreased from a mean 27.3 tablets to a mean 14.8 tablets with no significant increase in refill requests. (p < 0.001)
Conclusion/Implications: These data suggest that implementing a patient based approach to post operative can significantly decrease the number of opiates prescribed at discharge without adverse consequences.
Methods: We retrospectively reviewed patients under an IRB exempt protocol who were undergoing gynecologic surgery on an enhanced recovery pathway (ERAS) from 12/2018 to 5/2019 at a tertiary academic institution; patients with post-operative complications, chronic pain or opiate abuse were excluded. Opiate usage in the 24 hours prior to discharge was evaluated using multivariable regression to control for demographic information, procedure type, opiate requirement while admitted and pain scores. Discharge opiate prescription recommendations were subsequently developed based on patient opiate use and implemented in discharge order sets in 03/2020. Patients discharged following implementation were followed prospectively from 07/2020 to 09/2020 to assess for quantity of opiate prescribed and refill requests.
Results: There were 220 patient in the pre-intervention cohort and 120 patients post intervention. Actual patient opiate usage in the pre-intervention cohort correlated only with pain score and age (p < 0.001, p=0.04), not procedure type; however, opiate prescribed were predominately procedure based. A standardized recommendation for opiate prescription based on opiate usage in the 24 hours prior to discharge was added to the discharge order set. Post intervention, opiate prescriptions decreased from a mean 27.3 tablets to a mean 14.8 tablets with no significant increase in refill requests. (p < 0.001)
Conclusion/Implications: These data suggest that implementing a patient based approach to post operative can significantly decrease the number of opiates prescribed at discharge without adverse consequences.
Introduction: The study objective was to evaluate patient factors associated with post-operative opiate usage and to utilize these data to develop and assess specific recommendations for post-operative opiate prescribing.
Methods: We retrospectively reviewed patients under an IRB exempt protocol who were undergoing gynecologic surgery on an enhanced recovery pathway (ERAS) from 12/2018 to 5/2019 at a tertiary academic institution; patients with post-operative complications, chronic pain or opiate abuse were excluded. Opiate usage in the 24 hours prior to discharge was evaluated using multivariable regression to control for demographic information, procedure type, opiate requirement while admitted and pain scores. Discharge opiate prescription recommendations were subsequently developed based on patient opiate use and implemented in discharge order sets in 03/2020. Patients discharged following implementation were followed prospectively from 07/2020 to 09/2020 to assess for quantity of opiate prescribed and refill requests.
Results: There were 220 patient in the pre-intervention cohort and 120 patients post intervention. Actual patient opiate usage in the pre-intervention cohort correlated only with pain score and age (p < 0.001, p=0.04), not procedure type; however, opiate prescribed were predominately procedure based. A standardized recommendation for opiate prescription based on opiate usage in the 24 hours prior to discharge was added to the discharge order set. Post intervention, opiate prescriptions decreased from a mean 27.3 tablets to a mean 14.8 tablets with no significant increase in refill requests. (p < 0.001)
Conclusion/Implications: These data suggest that implementing a patient based approach to post operative can significantly decrease the number of opiates prescribed at discharge without adverse consequences.
Methods: We retrospectively reviewed patients under an IRB exempt protocol who were undergoing gynecologic surgery on an enhanced recovery pathway (ERAS) from 12/2018 to 5/2019 at a tertiary academic institution; patients with post-operative complications, chronic pain or opiate abuse were excluded. Opiate usage in the 24 hours prior to discharge was evaluated using multivariable regression to control for demographic information, procedure type, opiate requirement while admitted and pain scores. Discharge opiate prescription recommendations were subsequently developed based on patient opiate use and implemented in discharge order sets in 03/2020. Patients discharged following implementation were followed prospectively from 07/2020 to 09/2020 to assess for quantity of opiate prescribed and refill requests.
Results: There were 220 patient in the pre-intervention cohort and 120 patients post intervention. Actual patient opiate usage in the pre-intervention cohort correlated only with pain score and age (p < 0.001, p=0.04), not procedure type; however, opiate prescribed were predominately procedure based. A standardized recommendation for opiate prescription based on opiate usage in the 24 hours prior to discharge was added to the discharge order set. Post intervention, opiate prescriptions decreased from a mean 27.3 tablets to a mean 14.8 tablets with no significant increase in refill requests. (p < 0.001)
Conclusion/Implications: These data suggest that implementing a patient based approach to post operative can significantly decrease the number of opiates prescribed at discharge without adverse consequences.
Optimizing post-operative opiate prescribing: An avenue to decrease excess opiate entry into communities
Katherine Croft
Abstract
Discussion Forum (0)
Introduction: The study objective was to evaluate patient factors associated with post-operative opiate usage and to utilize these data to develop and assess specific recommendations for post-operative opiate prescribing.
Methods: We retrospectively reviewed patients under an IRB exempt protocol who were undergoing gynecologic surgery on an enhanced recovery pathway (ERAS) from 12/2018 to 5/2019 at a tertiary academic institution; patients with post-operative complications, chronic pain or opiate abuse were excluded. Opiate usage in the 24 hours prior to discharge was evaluated using multivariable regression to control for demographic information, procedure type, opiate requirement while admitted and pain scores. Discharge opiate prescription recommendations were subsequently developed based on patient opiate use and implemented in discharge order sets in 03/2020. Patients discharged following implementation were followed prospectively from 07/2020 to 09/2020 to assess for quantity of opiate prescribed and refill requests.
Results: There were 220 patient in the pre-intervention cohort and 120 patients post intervention. Actual patient opiate usage in the pre-intervention cohort correlated only with pain score and age (p < 0.001, p=0.04), not procedure type; however, opiate prescribed were predominately procedure based. A standardized recommendation for opiate prescription based on opiate usage in the 24 hours prior to discharge was added to the discharge order set. Post intervention, opiate prescriptions decreased from a mean 27.3 tablets to a mean 14.8 tablets with no significant increase in refill requests. (p < 0.001)
Conclusion/Implications: These data suggest that implementing a patient based approach to post operative can significantly decrease the number of opiates prescribed at discharge without adverse consequences.
Methods: We retrospectively reviewed patients under an IRB exempt protocol who were undergoing gynecologic surgery on an enhanced recovery pathway (ERAS) from 12/2018 to 5/2019 at a tertiary academic institution; patients with post-operative complications, chronic pain or opiate abuse were excluded. Opiate usage in the 24 hours prior to discharge was evaluated using multivariable regression to control for demographic information, procedure type, opiate requirement while admitted and pain scores. Discharge opiate prescription recommendations were subsequently developed based on patient opiate use and implemented in discharge order sets in 03/2020. Patients discharged following implementation were followed prospectively from 07/2020 to 09/2020 to assess for quantity of opiate prescribed and refill requests.
Results: There were 220 patient in the pre-intervention cohort and 120 patients post intervention. Actual patient opiate usage in the pre-intervention cohort correlated only with pain score and age (p < 0.001, p=0.04), not procedure type; however, opiate prescribed were predominately procedure based. A standardized recommendation for opiate prescription based on opiate usage in the 24 hours prior to discharge was added to the discharge order set. Post intervention, opiate prescriptions decreased from a mean 27.3 tablets to a mean 14.8 tablets with no significant increase in refill requests. (p < 0.001)
Conclusion/Implications: These data suggest that implementing a patient based approach to post operative can significantly decrease the number of opiates prescribed at discharge without adverse consequences.
Introduction: The study objective was to evaluate patient factors associated with post-operative opiate usage and to utilize these data to develop and assess specific recommendations for post-operative opiate prescribing.
Methods: We retrospectively reviewed patients under an IRB exempt protocol who were undergoing gynecologic surgery on an enhanced recovery pathway (ERAS) from 12/2018 to 5/2019 at a tertiary academic institution; patients with post-operative complications, chronic pain or opiate abuse were excluded. Opiate usage in the 24 hours prior to discharge was evaluated using multivariable regression to control for demographic information, procedure type, opiate requirement while admitted and pain scores. Discharge opiate prescription recommendations were subsequently developed based on patient opiate use and implemented in discharge order sets in 03/2020. Patients discharged following implementation were followed prospectively from 07/2020 to 09/2020 to assess for quantity of opiate prescribed and refill requests.
Results: There were 220 patient in the pre-intervention cohort and 120 patients post intervention. Actual patient opiate usage in the pre-intervention cohort correlated only with pain score and age (p < 0.001, p=0.04), not procedure type; however, opiate prescribed were predominately procedure based. A standardized recommendation for opiate prescription based on opiate usage in the 24 hours prior to discharge was added to the discharge order set. Post intervention, opiate prescriptions decreased from a mean 27.3 tablets to a mean 14.8 tablets with no significant increase in refill requests. (p < 0.001)
Conclusion/Implications: These data suggest that implementing a patient based approach to post operative can significantly decrease the number of opiates prescribed at discharge without adverse consequences.
Methods: We retrospectively reviewed patients under an IRB exempt protocol who were undergoing gynecologic surgery on an enhanced recovery pathway (ERAS) from 12/2018 to 5/2019 at a tertiary academic institution; patients with post-operative complications, chronic pain or opiate abuse were excluded. Opiate usage in the 24 hours prior to discharge was evaluated using multivariable regression to control for demographic information, procedure type, opiate requirement while admitted and pain scores. Discharge opiate prescription recommendations were subsequently developed based on patient opiate use and implemented in discharge order sets in 03/2020. Patients discharged following implementation were followed prospectively from 07/2020 to 09/2020 to assess for quantity of opiate prescribed and refill requests.
Results: There were 220 patient in the pre-intervention cohort and 120 patients post intervention. Actual patient opiate usage in the pre-intervention cohort correlated only with pain score and age (p < 0.001, p=0.04), not procedure type; however, opiate prescribed were predominately procedure based. A standardized recommendation for opiate prescription based on opiate usage in the 24 hours prior to discharge was added to the discharge order set. Post intervention, opiate prescriptions decreased from a mean 27.3 tablets to a mean 14.8 tablets with no significant increase in refill requests. (p < 0.001)
Conclusion/Implications: These data suggest that implementing a patient based approach to post operative can significantly decrease the number of opiates prescribed at discharge without adverse consequences.
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