Opioid Stewardship: Successful, Scalable, and Adaptable Departmental Opioid Reduction Program

Single-phase efforts to reduce opioid prescriptions after surgery have been somewhat effective. This is the first report of a low-cost, scalable, and self-sustaining opioid stewardship program spanning all perioperative phases.

We implemented a comprehensive opioid stewardship program comprised of multimedia patient- and staff-directed educational materials, prescribing badges, 4 electronic medical record modifications, and a dashboard that tracked and analyzed opioid prescribing. A retrospective analysis of baseline discharge prescribing habits (2019) was compared with prospective postimplementation data (2021 to 2022). Opioid naive adults undergoing 1 of 15 elective procedures in the short-term care, colorectal, thoracic, transplant, and surgical oncology divisions at our institution were included. Primary outcomes included discharge prescription size (normalized to oxycodone 5 mg pills), percent reduction of opioids, and percentage of patients requiring postdischarge opioid prescription.

A total of 6,619 adults (median age 59 years [interquartile range 36 to 82 years]; 69.7% woman) were enrolled, 2,334 before and 4,285 after implementation. Overall, median (interquartile range) prescription size decreased (5 [0 to 15] to 0 [0 to 5; p < 0.0001]) and average (SD) decreased from 8.7 ± 12.9 to 2.9 ± 7.1 for a 67.1% reduction and a savings of 24,212 pills. A reduction in median discharge opioid prescription was achieved in 14 of 15 procedures (all p < 0.05, range 37.1% to 89.6%), and the median postintervention prescription quantity was 0 for 10 of 15 procedures. After risk adjustment, postintervention patients discharged with opioid prescriptions received 8 fewer oxycodone 5 mg pills (p < 0.0001). The postintervention period was associated with increased odds of discharge on-target (odds ratio [OR] 8.9 [7.74 to 10.18] and opioid-free discharge (OR 3.4 [3.06 to 3.87]) and reduced odds of receiving a prescription refill (OR 0.72 [0.59 to 0.88]). Compared with patients who were discharged without opioids, those who were discharged with an opioid prescription had increased odds of receiving another postdischarge prescription (OR 3.90 [3.12 to 4.86]).

This low-cost, self-sustaining departmental opioid stewardship program was remarkably effective at reducing opioid overprescription at discharge after common operations.