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Reducing opioid overprescribing through procedure-specific prescribing guidelines
Kevin Zhang; Kevin Blum, PhD; Jacqueline J Chu; Roman Skoracki, MD; Jeffrey E. Janis, MD; Jenny C. Barker, MD, PhD
Ohio State University
2022-01-15
Presenter: Kevin Zhang
Affidavit:
This submission represents 100% original work from the corresponding author, Jenny C Barker, Kevin Zhang as the presenter and the rest of the medical student and faculty team listed. Specifically, Kevin Zhang collected, analyzed and interpreted data and was primarily responsible for writing this work.
Director Name: Gregory Pearson
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: General Reconstruction
Background: Despite advances in post-operative opioid-sparing pain management, post-discharge opioid overprescribing in plastic surgery remains an issue. Procedure-specific prescribing protocols have been implemented successfully in other surgical specialties but not broadly in plastic surgery. This study examined the efficacy of procedure-specific opioid prescribing guidelines for reducing post-discharge opioid overprescribing.
Methods: A total of 561 plastic surgery patients were evaluated retrospectively after a procedure-specific prescribing guideline, which recommended prescription amounts after discharge based on type of operation, was introduced in July 2020. Prescription and post-discharge opioid consumption amounts before (n=428) and after (n=133) implementation of the guideline were compared. Patient satisfaction and prescription frequency of non-opioid analgesia were also compared.
Results: The average number of opioid pills per prescription decreased by 25% from 19.3 (27.4 OME) to 15.0 (22.7 OME; p=0.001) after the procedure-specific guideline was implemented, with no corresponding decrease in the average number of post-discharge opioid pills consumed [10.6 (15.1 OME) to 8.2 (12.4 OME); p=0.147]. Neither patient satisfaction with pain management (9.6 to 9.6; p>0.99) nor communication (9.6 to 9.5; p>0.99) was affected. The rate of opioid-only prescription regimens decreased from 17.9% to 7.6% (p=0.01), and more patients were prescribed at least 2 non-opioid analgesics (27.5% to 42.9%; p=0.003) with their opioid prescription. The rate of scheduled acetaminophen prescription, in particular, increased (54.7% to 71.4%; p=0.002).
Conclusions: A procedure-specific prescribing model is a straight-forward intervention to promote safer opioid prescribing practices in plastic surgery. Its usage in clinical practice may lead to more appropriate opioid prescribing.
