A Program to Reduce Post-Operative Opioid Prescribing at a Veteran's Affairs Hospital

Area of Science:

• Health Policy
• Clinical Pharmacy
• Surgical Outcomes

Background:

• Surgeon prescribing variability contributes to opioid dependence and addiction.
• Overprescribing opioids post-surgery is a significant public health concern.

Purpose of the Study:

• To reduce opioid overprescribing in surgical procedures at the Veteran's Affairs Pittsburgh Healthcare System (VAPHS).
• To evaluate the impact of new opioid prescribing guidelines on post-operative opioid utilization.

Main Methods:

• Development of standardized opioid prescribing guidelines for general, thoracic, and vascular surgery.
• Integration of bundled order sets into the electronic medical system workflow.
• Retrospective cohort study comparing opioid prescription data pre- and post-guideline implementation.

Main Results:

• Statistically significant reductions in morphine milligram equivalents (MME), pill quantity, and days prescribed for procedures with guidelines (cholecystectomy, inguinal, and umbilical hernia repair).
• Example: Cholecystectomy MME reduced from 140.8 to 57.5 (p=0.002).
• Observed decrease in opioid prescribing for procedures without specific guidelines, suggesting an indirect effect of practice change.

Conclusions:

• Post-operative opioid prescribing guidelines effectively guide clinicians toward more judicious opioid dispensing.
• Implementation of guidelines can lead to significant reductions in opioid use and potentially mitigate risks of dependence and addiction.