Reduction in unnecessary postoperative opioid prescription among patients undergoing inpatient gynecologic surgery by standardizing postoperative prescribing practices (499)

Abstract

<b>Objectives:</b> In this quality improvement initiative, we sought to reduce the amount of unutilized and unnecessary opioid prescriptions given to patients following gynecologic surgery. <b>Methods:</b> Opioid-naïve patients over the age of 18 years who underwent inpatient gynecologic surgery at our institution were included in this quality improvement initiative. A 3-month pre-intervention evaluation of the number of opioid pills prescribed, the number of pills taken, acetaminophen and non-steroidal anti-inflammatory taken, and additional refills, were obtained by contacting patients via phone 7-10 days following discharge. After 100 consecutive patients were contacted and data collected, we standardized discharge opioid prescriptions to supply a total of 10 tablets to eligible patients. One hundred patients were contacted in this post-intervention phase, and data were collected. Appropriate statistical tests were utilized to compare between the pre- and post-intervention groups. <b>Results:</b> A total of 197 patients completed our survey when contacted following discharge (97 pre-intervention, 100 post-intervention). In the pre-intervention group, the median number of opioids prescribed was 22 pills (range: 0-60) and in the post-intervention group was 10 (range 0-60) (p< 0.001). The median number of pills consumed pre-intervention was 2 (range: 0-51) and 3 in the postintervention group (range: 0-50) (p = 0.668). Among all 197 patients, 75 patients (38.1%) took no opioids following discharge (40.6% of patients pre-intervention, 35.6% of patients post-intervention). There were no differences among the pre- and post-intervention groups with respect to age, the type of procedure performed, type of incision, post-discharge acetaminophen consumed, post-discharge NSAID consumed, or additional pain medication refill. <b>Conclusions:</b> Standardizing prescribing patterns following inpatient gynecologic surgery dramatically reduces unnecessary and unused opioids while having no effect on opioid consumption or the need for a refill. More than one-third of patients undergoing gynecologic surgery require no opioids following discharge. Efforts to individualize opioid prescriptions are needed to further reduce unnecessary opioid prescriptions.