Spillover Effect of Evidence-Based Postoperative Opioid Prescribing

Opioid prescribing after operations is often excessive, resulting in leftover pills in the community available for diversion. Procedure-specific postoperative prescribing guidelines can reduce excessive prescribing, however, it is unclear whether such guidelines are associated with reductions in opioid prescribing for other procedures.

A retrospective chart review was conducted for patients undergoing laparoscopic appendectomy, laparoscopic inguinal hernia repair, laparoscopic sleeve gastrectomy, and thyroidectomy/parathyroidectomy between January 1, 2016 and August 31, 2017. Postoperative opioid prescription size (in oral morphine equivalents [OME]) was compared before and after November 1, 2016, when prescribing guidelines were introduced for laparoscopic cholecystectomy. An interrupted time series analysis was conducted to evaluate changes in opioid prescribing after this intervention.

A total of 1,158 patients were included in the cohort (558 pre-intervention, 600 post-intervention). Opioid prescription size was significantly reduced for laparoscopic sleeve gastrectomy (447.6 ± 74.3 OME vs 291.9 ± 104.3 OME; p < 0.001), laparoscopic appendectomy (173.7 ± 101.6 OME vs 85.8 ± 52.7 OME; p < 0.001), laparoscopic inguinal hernia repair (185.0 ± 101.8 OME vs 107.9 ± 57.9 OME; p < 0.001), and thyroidectomy/parathyroidectomy (81.5 ± 52.8 OME vs 42.6 ± 22.5 OME; p < 0.001). Interrupted time series analysis revealed that this reduction was attributable to intervention for laparoscopic sleeve gastrectomy (-24.5 ± 5.3 OME; p = 0.001), laparoscopic appendectomy (-50.2 ± 28.7 OME; p = 0.04), and thyroidectomy/parathyroidectomy (-28.8 ± 9.4 OME; p = 0.001). For laparoscopic inguinal hernia repair, the immediate decrease in prescription size was not statistically significant (-38.8 ± 33.1 OME; p = 0.24). There was a significant increase in requests for refills after laparoscopic appendectomy (0.8% vs 6.6%; p = 0.01) but not for other procedures.

After implementing evidence-based opioid prescribing recommendations for a single surgical procedure, opioid prescribing decreased for 4 other surgical procedures. Requests for refills did not increase substantially. This spillover effect demonstrates the potential impact of raising awareness about safe and appropriate opioid prescribing after operations.