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Optimizing opioid prescriptions after laparoscopic appendectomy and cholecystectomy

Adina E Feinberg1, Sergio A Acuna1, David Smith1

  • 1From the Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA (Feinberg); the Department of Surgery, University of Toronto, Toronto, Ont. (Acuna); the Department of Surgery, North York General Hospital, Toronto, Ont. (Smith); the Department of Anesthesia, North York General Hospital, Toronto, Ont. (Kashin, Mocon, Yau, Srikandarajah) and the Department of Pharmacy, North York General Hospital, Toronto, Ont. (Chiu).

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Summary

A quality improvement intervention significantly reduced opioid prescribing and consumption after laparoscopic appendectomy and cholecystectomy. Standardized prescriptions decreased opioid use without impacting patient satisfaction with pain management.

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Area of Science:

  • Surgical analgesia
  • Pain management
  • Public health

Background:

  • Rising opioid use and related deaths necessitate better prescribing practices.
  • Opioid prescriptions for surgical patients have increased.
  • Postoperative pain management requires careful consideration of opioid use.

Purpose of the Study:

  • To assess opioid consumption in patients undergoing laparoscopic appendectomy (LA) and laparoscopic cholecystectomy (LC).
  • To determine if a standardized prescription impacts opioid consumption and patient satisfaction.
  • To evaluate the effectiveness of a quality improvement intervention in reducing postoperative opioid use.

Main Methods:

  • Prospective study with two phases: usual prescribing and standardized prescription.
  • Patients undergoing LA or LC were recruited.
  • Postoperative opioid consumption and patient satisfaction were assessed via telephone questionnaires.

Main Results:

  • The initial phase showed a median of 20 prescribed and 2 consumed opioid tablets, with 95% patient satisfaction.
  • Implementation of a standardized prescription (10 opioid tablets) led to a significant decrease in median opioid pills filled (10) and consumed (0).
  • Patient satisfaction with analgesia remained consistent across both phases.

Conclusions:

  • Patients undergoing LA or LC are often prescribed excess opioids.
  • A standardized prescription protocol, as a quality improvement intervention, effectively reduced opioid prescribing and consumption.
  • This approach successfully decreased opioid use without compromising patient satisfaction.