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Original research
Evaluation of a tiered opioid prescription algorithm in an ERAS pathway: exploring opportunities for further refinement
  1. M Sol Basabe1,
  2. Tina S Suki1,
  3. Mark F Munsell2,
  4. Maria D Iniesta1,
  5. Juan E Garcia Lopez1,
  6. Robert Tyler Hillman1,
  7. Katherine Cain3,
  8. Sarah Huepenbecker1,
  9. Gabriel Mena4,
  10. Jolyn S Taylor1,
  11. Pedro T Ramirez1 and
  12. Larissa A Meyer1
  1. 1Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  2. 2Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  3. 3Department of Pharmacy Clinical Programs, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  4. 4Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  1. Correspondence to Dr Larissa A Meyer, Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, 77030, USA; lmeyer{at}mdanderson.org

  • Present affiliation The present affiliation of Juan E Garcia Lopez is: Department of Family Medicine, The University of Texas Rio Grande Valley, McAllen, Texas, USA

  • Present affiliation The present affiliation of Pedro T Ramirez is: Department of Obstetrics and Gynecology, Houston Methodist Hospital, Houston, Texas, USA

Abstract

Background Opioid over-prescription is wasteful and contributes to the opioid crisis. We implemented a personalized tiered discharge opioid protocol and education on opioid disposal to minimize over-prescription.

Objective To evaluate the intervention by investigating opioid use post-discharge for women undergoing abdomino-pelvic surgery, and patient adherence to opioid disposal education.

Methods We analyzed post-discharge opioid consumption among 558 patients. Eligible patients included those who underwent elective gynecologic surgery, were not taking scheduled opioids pre-operatively, and received discharge opioids according to a tiered prescribing algorithm. A survey assessing discharge opioid consumption and disposal safety knowledge was distributed on post-discharge day 21. Over-prescription was defined as >20% of the original prescription left over. Descriptive statistics were used for analysis.

Results The survey response rate was 61% and 59% in the minimally invasive surgery and open surgery cohorts, respectively. Overall, 42.8% of patients reported using no opioids after hospital discharge, 45.2% in the minimally invasive surgery and 38.6% in the open surgery cohort. Furthermore, 74.9% of respondents were over-prescribed, with median age being statistically significant for this group (p=0.004). Finally, 46.4% of respondents expressed no knowledge regarding safe disposal practices, with no statistically significant difference between groups (p>0.99).

Conclusion Despite implementation of the tiered discharge opioid algorithm aimed to personalize opioid prescriptions to estimated need, we still over-prescribed opioids. Additionally, despite targeted education, nearly half of all patients who completed the survey did not know how to dispose of their opioid tablets. Additional efforts are needed to further refine the algorithm to reduce over-prescription of opioids and improve disposal education.

  • Gynecologic Surgical Procedures
  • Pain
  • Postoperative Period
  • Opioid-Related Disorders

Data availability statement

No data are available. Our protocol does not currently allow data sharing outside of the institution.

https://doi.org/10.1136/ijgc-2023-004948

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    Data availability statement

    No data are available. Our protocol does not currently allow data sharing outside of the institution.

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    Footnotes

    • Twitter @SolBasabe, @RTylerHillmanMD, @sarah_huep, @gabemenaMD, @TaylorJolyn, @pedroramirezMD

    • MSB and TSS contributed equally.

    • Contributors This is a multidepartment and multidisciplinary effort where all authors have significantly contributed to the planning, execution, or analysis of our study and have read and approved the final version of the manuscript. LAM acted as the guarantor, accepts full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish.

    • Funding Financial support for this research investigation was provided in part by grant funding to the following individuals: SH – Research support from National Institutes of Health T32 grant (#5T32 CA101642). LAM – Research support from National Cancer Institute K award (#K07 CA201013). University of Texas MD Anderson Cancer Center: National Cancer Institute Cancer Center Support Grant (P30 48CA016672). RTH- Research support from CPRIT award Scholar in Cancer Research, CPRIT, Austin, Texas, USA

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.