Decreasing opioid prescribing at discharge while maintaining adequate pain management is sustainable

In 2018, using a pragmatic multimodal approach, discharge opioid prescriptions were reduced without affecting pain control management. Herein, we assessed whether this approach was sustainable and whether discharge opioid prescriptions could be further reduced.

This is a single center prospective study of patients who underwent elective outpatient procedures provided by our institution's Acute Care Surgery Division surgeons. Adult patients who underwent elective surgeries performed by surgeons in the Division of Acute Care Surgery from November 2018 to June 2021 and agreed to participate were included. The opioid prescriptions pre-populated in the order set at discharge were reduced from 20 pills to 10 pills in May 2020. Demographics, opioid information, non-opioid adjuncts prescribed, reported use of opioids prescribed, and patients' satisfaction were collected. Opioids were converted to oral morphine equivalents (OME).

A total of 178 patients were included. Elective surgeries performed mainly included inguinal hernia repair (38.8%), laparoscopic cholecystectomy (30.3%), cyst excision (13.5%), and umbilical hernia (8.4%). One hundred twenty-five and 53 patients underwent an elective operation with a surgeon in the Acute Care Surgery Division before and after the number of opioids pre-populated in the order set at discharge was reduced from 20 pills to 10 pills, respectively. Reducing the pre-populated discharge opioid prescriptions led to a significant decrease in OME prescribed (75 [75-76.5] vs. 80 [75-150], p < 0.001) without affecting patients' satisfaction with pain management (excellent/good: 87.8% vs. 84%; p = 0.305).

Our pragmatic multimodal approach is sustainable and allows for additional opioid prescription reduction without affecting patients' satisfaction with pain management.