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Abstract
Objective To compare discharge opioid refills, prescribed morphine equivalent dose and quantity, and longitudinal patient-reported outcomes before and after implementation of a tiered opioid prescribing algorithm among women undergoing open gynecologic surgery within an enhanced recovery after surgery program.
Methods We compared opioid prescriptions, clinical outcomes, and patient-reported outcomes among 273 women. Post-discharge symptom burden was collected up to 42 days after discharge using the validated 27-item MD Anderson Symptom Inventory and analyzed using linear mixed effects models and Kaplan–Meier curves for symptom recovery.
Results Among 113 pre-implementation and 160 post-implementation patients there was no difference in opioid refills (9.7% vs 11.3%, p=0.84). The post-implementation cohort had a significant reduction in median morphine equivalent dose (112.5 mg vs 225 mg, p<0.01), with no difference in median hospital length of stay (3 days vs 3 days, p=1.0) or 30-day readmission rate (9.4% vs 7.1%, p=0.66). There was no difference in patient-reported pain between the pre- and post-implementation cohorts on the day of discharge (severity 4.93 vs 5.14, p=0.53) or in any patient-reported symptoms, interference measures, or composite scores by post-discharge day 7. The median recovery time for most symptoms was 7 days, except for pain (14 days), fatigue (18 days), and physical interference (21 days), with no differences between cohorts.
Conclusions After implementation of a tiered opioid prescribing algorithm, the quantity and dose of discharge opioids prescribed decreased with no change in post-operative refills and without negatively impacting patient-reported symptom burden or interference, which can be used to educate and reassure patients and providers.
- gynecologic surgical procedures
- opioid-related disorders
- postoperative care
Data availability statement
All data relevant to the study are included in the article or uploaded as supplementary information. Study data were collected and managed using Research Electronic Data Capture tools hosted at MD Anderson as part of an institutionally approved quality improvement study. In accordance with the journal’s guidelines, we will provide our data for the reproducibility of this study in other centers if such is requested.
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Data availability statement
All data relevant to the study are included in the article or uploaded as supplementary information. Study data were collected and managed using Research Electronic Data Capture tools hosted at MD Anderson as part of an institutionally approved quality improvement study. In accordance with the journal’s guidelines, we will provide our data for the reproducibility of this study in other centers if such is requested.
Footnotes
Twitter @sarah_huep, @gabemenaMD, @TaylorJolyn, @pedroramirezMD
Contributors SH: Investigation, writing – original draft. RTH: Conceptualization, methodology, investigation, formal analysis. MDI: Software, validation, investigation, project administration. TC: Formal analysis. KC: Validation, writing – review and editing. GM: Writing – review and editing. JL: Writing – review and editing. XSW: Conceptualization. LW: Conceptualization, Writing – review and editing. JST: Conceptualization, methodology, writing – review and editing. KHL: Supervision. PTR: Supervision, writing – review and editing. LAM: Conceptualization, methodology, supervision, writing – review and editing.
Funding This work was supported in part by the MD Anderson Cancer Center Support Grant from the National Cancer Institute of the National Institutes of Health (NIH/NCI P30 CA016672, CA217685) and the T32 training grant CA101642 (SPH). LAM is supported by a NIH-NCIK07-CA201013 grant. XSW is supported by NCI/NIH “Improving Recovery After Major Cancer Surgery Using Patient-Reported Outcomes”, R01CA205146.
Competing interests LAM reports research funding from AstraZeneca, consulting for GlaxoSmithKline, and stocks in Crispr and Bristol-Myers Squibb. LW reports grants from AstraZeneca, Astellas, Bayer, Bristol Meyers Squibb, Genentech, Merck, and Eli Lily. GM reports a research/academic grant from PACIRA Pharmaceutical.
Provenance and peer review Not commissioned; externally peer reviewed.
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