Clinical Decision Support to Reduce Opioid Prescribing at Discharge for Inpatients Undergoing Surgery (LESS Study):...

Area of Science:

• Health Informatics
• Clinical Pharmacology
• Public Health

Background:

• Unnecessary opioid prescribing post-surgery contributes to misuse and adverse health outcomes.
• A system-wide clinical decision support (CDS) intervention was implemented to address this issue.

Purpose of the Study:

• To evaluate the effectiveness of a CDS intervention in reducing opioid prescribing at discharge.
• To assess the impact on total oxycodone prescribed in morphine milligram equivalents (MME).

Main Methods:

• An interrupted time series design was used, analyzing adult surgical patients hospitalized for at least 24 hours.
• Data from two-year pre- and post-intervention periods were compared (2/13/21-2/12/25).
• Segmented regression models analyzed primary (discharge oxycodone MME) and secondary outcomes (any opioid prescription, quantity).

Main Results:

• Total oxycodone prescribed per discharge decreased from 27.4 MME pre-intervention to 16.5 MME post-intervention.
• A significant reduction in discharge oxycodone MME was observed (geometric mean ratio 0.83, P <0.001).
• The proportion of discharges with any opioid prescription decreased from 21% to 18% (relative risk 0.87).

Conclusions:

• An automated, real-time CDS tool effectively reduced clinically significant amounts of oxycodone prescribed at discharge.
• Simple CDS tools integrated into EHR systems can reduce unnecessary opioid prescriptions at scale.
• This intervention aligns with guideline-concordant care and may mitigate opioid misuse risks.