Optimizing opioid prescribing practices after minimally invasive lung resection through a quality-improvement...

Area of Science:

• Thoracic Surgery
• Pain Management
• Quality Improvement

Background:

• The Canadian Association of Thoracic Surgeons (CATS) guideline recommends 120 morphine milligram equivalents (MME) post-elective ambulatory thoracic surgery.
• Optimizing opioid prescribing after video-assisted thoracoscopic surgery (VATS) lung resection is crucial for patient recovery.

Purpose of the Study:

• To implement and assess the impact of the CATS guideline on opioid prescribing after VATS lung resection.
• To reduce the average MME of discharge opioid prescriptions and the proportion of non-adherent prescriptions.

Main Methods:

• A quality improvement project incorporating the CATS guideline and a patient information handout was implemented.
• Data on opioid discharge prescriptions and refills were collected and analyzed using control charts for pre- and post-intervention periods.

Main Results:

• Average MME of discharge prescriptions decreased significantly from 158 to 100 post-intervention (p < 0.001).
• The proportion of non-adherent prescriptions decreased from 50.9% to 18.9% (p < 0.001).
• No significant difference was observed in opioid prescription refill rates.

Conclusions:

• Implementation of the CATS opioid guideline led to a significant reduction in prescribed opioids at discharge.
• The quality improvement initiative demonstrated successful optimization of opioid prescribing without compromising pain management, as evidenced by stable refill rates.
• Control charts are effective tools for monitoring intervention outcomes in surgical pathways.