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5x-Multiplier vs 3-Tier Model for Discharge Opioid Prescriptions After Intra-Abdominal Cancer Surgery: Randomized
Brittany C Fields1, Timothy E Newhook1, Heather A Lillemoe2
1Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center.
Advances in Cancer Education and Quality Improvement
|June 30, 2025
Summary
This study compares two opioid prescribing models for cancer surgery patients to reduce oral morphine equivalents (OME) at discharge and consumption post-surgery. The goal is to find a model that lowers opioid use without impacting pain control or patient satisfaction.
Area of Science:
- Oncology
- Surgery
- Pharmacology
- Clinical Trials
Background:
- Surgeons account for a significant portion of opioid prescriptions, with over one-third of surgeon-prescribed medications being opioids.
- Initial opioid quantity prescribed at discharge correlates with patient consumption and persistent opioid use.
- Current opioid prescribing practices vary widely due to a lack of standardized protocols.
Purpose of the Study:
- To identify an opioid prescribing model that minimizes oral morphine equivalents (OME) prescribed at discharge and consumed within 14 days post-discharge.
- To ensure that the chosen model does not adversely affect prescription refills, patient quality of life, or satisfaction.
Main Methods:
- A pragmatic, single-center, multispecialty, double-arm phase II randomized clinical trial.
- Adult patients undergoing specific open abdominal oncologic operations with curative intent were eligible.
- Patients were randomized to receive discharge opioid prescriptions based on either the 5x-multiplier algorithm or the 3-tier model.
Main Results:
- The study aims to compare initial discharge OME volume and 14-day post-discharge OME consumption between the two models.
- Secondary outcomes include rates of zero OME at discharge, refill requests, unused pills, persistent opioid use, and patient-reported quality of life.
- Analysis will involve two-sample t-tests and linear regression models to assess differences.
Conclusions:
- The study will evaluate the effectiveness of two distinct opioid prescribing models in reducing postoperative opioid use.
- Findings will inform the development of standardized protocols to optimize opioid prescribing in surgical oncology.
- The trial aims to establish a best practice for opioid management post-cancer surgery.
