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Area of Science:

  • Surgery
  • Pharmacology
  • Public Health

Background:

  • Previous single-phase efforts to curb surgical opioid prescriptions showed limited success.
  • This study introduces the first report of a comprehensive, low-cost, scalable, and self-sustaining opioid stewardship program covering all perioperative phases.

Purpose of the Study:

  • To evaluate the effectiveness of a newly implemented, multi-faceted opioid stewardship program in reducing opioid overprescription at surgical discharge.
  • To assess the program's impact on prescription size, opioid reduction percentages, and the need for post-discharge opioid prescriptions.

Main Methods:

  • A comprehensive opioid stewardship program was implemented, including educational materials, prescribing badges, EMR modifications, and a prescribing dashboard.
  • A retrospective analysis compared baseline (2019) opioid prescribing data with prospective data (2021-2022) from opioid-naive adult patients undergoing 15 elective procedures.
  • Primary outcomes measured were discharge prescription size, percentage reduction in opioids, and the rate of patients requiring post-discharge opioid prescriptions.

Main Results:

  • The study included 6,619 adult patients (2,334 pre-implementation, 4,285 post-implementation).
  • Median discharge prescription size decreased significantly (p < 0.0001), with a 67.1% overall reduction in opioid pills (24,212 saved).
  • Post-intervention, 14 of 15 procedures showed reduced median discharge opioid prescriptions, and 10 procedures achieved a median of 0 pills. Patients discharged with opioids received 8 fewer oxycodone 5 mg pills (p < 0.0001) and had increased odds of opioid-free discharge (OR 3.4).

Conclusions:

  • The implemented opioid stewardship program proved highly effective in reducing opioid overprescription at discharge for common surgical procedures.
  • The program's low-cost and self-sustaining nature makes it a scalable model for other institutions seeking to optimize opioid prescribing practices.