Optimizing post-operative opiate prescribing following gynecologic surgery.

Area of Science:

• Pain Management
• Surgical Outcomes
• Pharmacology

Background:

• Traditional post-operative opiate prescribing relies on procedure type, often overlooking individual patient consumption patterns.
• There is a need to evaluate factors influencing patient opiate use after surgery to optimize prescribing practices.

Purpose of the Study:

• To identify peri-operative factors associated with post-operative opiate utilization.
• To develop and implement a discharge prescribing intervention based on patient opiate usage.
• To assess the impact of this intervention on opiate prescribing and refill requests.

Main Methods:

• A quality improvement study comparing pre- and post-intervention cohorts of patients undergoing gynecologic surgery on an enhanced recovery pathway (ERAS).
• Analysis of peri-operative factors (demographics, procedure, pain scores) and opiate usage in the pre-intervention phase.
• Implementation of a discharge planning intervention informed by 24-hour opiate usage prior to discharge.

Main Results:

• Post-operative opiate usage was correlated with pain score and age, while prescribed quantity was linked to procedure type.
• The intervention led to a significant decrease in prescribed opiate tablets, from a mean of 27.3 to 14.8.
• Post-intervention adherence to recommended prescribing was 40.8%.

Conclusions:

• A patient-specific approach to post-operative opiate prescribing significantly reduces the quantity of opiates prescribed.
• Tailoring prescriptions based on individual patient usage is more effective than procedure-based stratification.