Impacts of opioid stewardship in surgical settings: a scoping review

Opioid stewardship programs have been implemented in many countries to reduce harms related to prescription opioid use. Yet, there is an evidence gap on the impact of these programs in surgical settings. This systematic scoping review aimed to examine the impact of opioid stewardship on opioid use and clinical outcomes, alongside assessing adherence, and barriers to its implementation in surgical settings. A systematic search strategy was developed and applied among 7 electronic databases for published literature. In total, 100 eligible articles were included in the review. Most studies showed that opioid stewardship reduced the quantity of opioid use (in 83/88 studies; 94%) and the number of days of opioid supplied (15/18; 83%). No effect was seen on the rate of opioid refills (34/44; 78%), postoperative pain scores (22/23; 96%), and length of hospital stay (12/15; 80%). The adherence rates ranged from 32% to 100%, with considerable heterogeneity in the indicators used to measure the quality use of opioids. Logistical issues, patients' demand for analgesics, clinicians' uncertainty regarding the efficacy of nonopioid analgesics, and a lack of role allocation were reported as major barriers to implementation. Opioid stewardship can improve the quality use of opioids without adversely affecting clinical outcomes. The variety of opioid stewardship types, measurement metrics, study designs, and different surgeries pose challenges in determining causal relationships. Future prospective studies using standardized approaches are needed to develop more robust evidence.