Patient-reported post-discharge opioid use after abdominal gynecologic surgery in an Enhanced Recovery After Surgery (ERAS) program (004)

Abstract

<b>Objectives:</b> Over prescription of opioids is a major contributor to the opioid crisis. In an attempt to reduce this issue, we implemented a personalized tiered discharge opioid protocol, which included safe opioid disposal education. We aimed to determine post-discharge patient-reported opioid use after implementing a tiered discharge opioid protocol among women undergoing abdominal gynecologic surgery under an enhanced recovery after surgery (ERAS) program. <b>Methods:</b> We analyzed post-discharge opioid consumption among 582 patients (369 minimally invasive [MIS] and 213 open surgery). Eligible patients included those who underwent elective surgery, were not taking scheduled opioids preoperatively, and had received 5, 15, or 30 tablets of 5 mg oxycodone as per a tiered opioid prescribing regimen. A survey assessing discharge opioid consumption and knowledge about safe disposal was sent to patients through REDCap on post-discharge day-21. The survey was completed via email or telephone within a 7-day window from receipt. Descriptive statistics were used for analysis. <b>Results:</b> Of the 369 MIS patients included, 192 (52%) had malignant diseases. The median age was 55 years (range: 18-89), and the median length of stay (LOS) for this group was 0 days (range: 0-4). A total of 95.9% of these patients received five tablets, 2.7% received 15 tablets, and 1.4% received 30 tablets (Figure 1A). Overall, the median total opioid use after discharge of this cohort was one tablet (mean: 2.2). In the MIS group, 43.6% of patients used no discharge opioids and had a median LOS of 0 days (range: 0-3). In addition, 9.8% reported using only one tablet, and 14.4% used five tablets (Figure 1B). Between days 21-28 after surgery, 1.4% of patients reported continued use of opioids, and 60% of them attributed this need to postoperative pain. Of the 213 patients who underwent open surgery, 172 (80.8%) had malignant diseases. The median age was 55 years (range: 20-88), and the median LOS was three days (range: 1-19). Following the tiered discharge opioid protocol, 37.1% of these patients received five tablets, 34.3% received 15 tablets, and 28.6% received 30 tablets (Figure 1A). Overall, the median total opioid use after discharge in this cohort was three tablets (mean: 7.7). Of the open surgery group, 35.2% of patients reported not using discharge opioids (Figure 1B). By days 21-28 after surgery, 8.9% of these patients were still requiring opioids, with 78.9% attributing this need to postoperative pain. Of the evaluated patients, 46% reported not being aware of proper opioid disposal practices. <b>Conclusions:</b> Despite implementing the tiered discharge opioid algorithm, we still overprescribed opioids. Our study showed that 43.6% of MIS patients and 35.2% of open surgery patients did not use any prescribed opioids after discharge. Additionally, despite targeted education, nearly half of all patients (46%) did not know how to dispose of their opioid tablets. This data will be applied to refine the algorithm to reduce over prescription of opioids and improve safe disposal.Fig. 1