Presentation Authors: Matthew Ziegelmann*, Jason Joseph, Amy Glasgow, Rochester, MN, Mark Tyson, Scottsdale, AZ, Raymond Pak, Jacksonville, FL, Halena Gazelka, Bradley Leibovich, Elizabeth Habermann, Matthew Gettman, Rochester, MN
Introduction: The United States faces an opioid epidemic, and surgeons must take action. However, a one-size fits all approach to opioid prescribing is sub-optimal. Here, we sought to evaluate changes in prescribing patterns after implementing a urologic-surgery specific postoperative opioid prescribing guideline at three tertiary care facilities.
Methods: We convened a urologic surgery opioid task force. Historical prescribing data for all adult patients without a history of chronic opioid use undergoing 21 urologic procedures at three tertiary care centers from 2015-2016 were used to derive an evidence-based, four-tiered guideline for postoperative opioid prescribing. Each tier contained procedures felt to be associated with similar levels of postoperative pain based on analysis of historical data and expert consensus. The guideline was implemented into clinical practice on January 1, 2018, and prescribing patterns including quantity of opioids prescribed (oral morphine equivalents = OME) and refill rates were compared for a cohort of patients undergoing surgery prior to (January 1 â€“ April 30, 2017; n=1,732) and after (January 1 â€“ April 30, 218; n=1376) implementation. The primary outcome was change in median OME prescribed after guideline implementation. Secondary outcomes include changes in refill rates and guideline adherence. Univariable analysis was performed using Wilcoxon Rank-Sum tests for continuous variables and Chi-squared tests for categorical variables.
Results: After guideline implementation, the median OME (IQR) prescribed was significantly lower for 2018 compared with 2017 [100 (0;175) versus 150 (60;225); p < .0001]. The median OME also significantly decreased for procedures in all guideline tiers with the exception of tier 0 where the median was stable at 0. The median prescribed OME decreased in 14/21 procedures (67%). The refill rates did not significantly change. Guideline adherence rates within the first four months after implementation, based on individual procedures, ranged from 33-95%.
Conclusions: Fewer opioids were prescribed after implementing the first iteration of our evidence-based prescribing guideline without a significant increase in prescription refills. However, further work is necessary including provider education and assessment of patient utilization of prescribed opioids.