A Prescribing Guideline Decreases Postoperative Opioid Prescribing in Emergency General Surgery. J Surg Res 2024 Jan;293:607-612
Date
10/15/2023Pubmed ID
37837815DOI
10.1016/j.jss.2023.09.012Scopus ID
2-s2.0-85173910473 (requires institutional sign-in at Scopus site)Abstract
INTRODUCTION: Patients prescribed higher opioid dosages have a higher risk of persistent opioid use, overdose, and death. There is a lack of standardization for opioid prescribing for acute surgical pain in emergency general surgery (EGS) patients. We hypothesized that implementing a guideline to standardize opioid prescribing would be associated with a decrease in prescribing at hospital discharge for EGS patients without increasing additional postdischarge refills.
METHODS: This was a quasi-experimental study evaluating opioid prescribing by EGS providers before and after the implementation of a prescribing guideline. Patients were assigned to preguideline and postguideline groups based on admission date surrounding the implementation of the guideline. The primary outcome was the proportion of patients receiving an opioid prescription for ≥50 Morphine Milligram Equivalents (MME) per day on hospital discharge.
RESULTS: There were 227 patients in the preguideline group and 226 patients in the postguideline group. After guideline implementation, median total MME prescribed decreased from 113 (interquartile range = 75) to 75 (interquartile range = 75, P = 0.03). The proportion of patients receiving a prescription for daily MME ≥50 also decreased from 75% to 25% (P ≤0.01). There were no increases in requested refills (17% versus 16%, P = 0.72) or received refills (14% versus 14%, P = 0.98). Guideline compliance ranged from 75% in ventral hernia repair patients to 94% in laparoscopic cholecystectomy patients.
CONCLUSIONS: A departmental guideline to standardize postoperative opioid prescriptions was associated with a decrease in the amount of MMEs prescribed to EGS patients without an increase in requested or received refills.
Author List
Biesboer EA, Al Tannir AH, Karam BS, Tyson K, Peppard WJ, Morris R, Murphy P, Elegbede A, de Moya MA, Trevino CAuthors
Abdul Hafiz Al Tannir MD Postdoctoral Fellow in the Surgery department at Medical College of WisconsinRachel S. Morris MD Assistant Professor in the Surgery department at Medical College of Wisconsin
William J. Peppard PharmD Trauma/Surgical Critical Care Pharmacist in the Pharmacy department at Froedtert Hospital
Colleen Trevino PhD APP Clinical Dir Inpatient 2 in the Surgery department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AftercareAnalgesics, Opioid
Humans
Pain, Postoperative
Patient Discharge
Practice Patterns, Physicians'
Retrospective Studies