Impact of policy-based and institutional interventions on postoperative opioid prescribing practices.

Titan A, Doyle A, Pfaff K, Baiu I, Lee A, Graham L, Shelton A, Hawn M. Impact of policy-based and institutional interventions on postoperative opioid prescribing practices. American journal of surgery. 2021 Oct 1; 222(4):766-772.

Related HSR&D Project(s)

• IIR 16-216 – Choosing Wisely: Barriers to De-Implementation, Patterns, and Costs of Low Value Preoperative Testing for Veterans Undergoing Low Risk Procedures

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Abstract:

BACKGROUND: We assessed the impact of policy-based and institutional interventions to limit postoperative opioid prescribing. METHODS: Retrospective cohort study of patients who underwent laparoscopic/open appendectomies, laparoscopic/open cholecystectomies, and laparoscopic/open inguinal hernia repair during a 6-month interval in 2018 (control), 2019 (post-policy intervention), and 2020 (post-institutional intervention) to assess changes in postoperative opioid prescribing patterns. A survey was collected for the 2020 cohort. RESULTS: Comparing the 762 patients identified in 2018, 2019, and 2020 cohorts there was a significant decrease in mean opioid tabs prescribed (23.5 ± 8.9 vs. 16.2 ± 7.0 vs. 12.8 ± 4.9, p  <  0.01) and mean OME dosage (148.0 ± 68.0 vs. 108.6 ± 51.8 vs. 95.4 ± 38.0, p  <  0.01), without a difference in refill requests. Patient survey (response rate 63%) indicated 91.4% of patients reported sufficient pain control. CONCLUSION: Formalized opioid-prescribing guidelines and statewide regulations can significantly decrease postoperative opioid prescribing with good patient satisfaction. Surgeon education may facilitate efforts to minimize narcotic over-prescription without compromising pain management.