Success of Hospital Intervention and State Legislation on Decreasing and Standardizing Postoperative Opioid Prescribing Practices

Abstract

We sought to evaluate change in postoperative prescription practices in an independent community-based hospital after hospital interventions and a state legislation change. This is a retrospective review of opioid-naïve adult subjects who underwent 5 common general surgical procedures between 2015 and 2017, including cholecystectomy, appendectomy, minimally invasive inguinal hernia repair, open inguinal hernia repair, and breast lumpectomy. Educational interventions were introduced, new statewide legislation was passed, and 129 subsequent cases were reviewed. Mean ± SD oral morphine equivalent (OME) prescribed for all procedures on retrospective review was 218.8 ± 113.7 (n= 722), cholecystectomy 235.3 ± 133.8 (n= 248), appendectomy 220.2 ± 103.2 (n= 175), open inguinal hernia repair 214.4 ± 97.2 (n= 119), minimally invasive inguinal hernia repair 187.7 ± 87.8 (n= 117), and lumpectomy 212.5 ± 114.5 (n= 63). There was significant variation in OME prescribed by procedure and by surgeon (p= 0.006 and p= 0.008, respectively). Review of post-intervention cases showed a significant reduction in the OME prescribed each year (mean OME 197.6 in 2015 to 2017 vs 72.3 in 2018; p < 0.005), and a 60% to 70% reduction in mean OME per procedure. Post-intervention data also revealed resolution of previously seen variation in prescription practices, and a significant increase in the percentage of patients prescribed multimodal pain therapy (23.5% in 2015 to 2017 to 31.5% in 2018; p < 0.05). We achieved a 60% to 70% decrease in postoperative opioid prescription at our community hospital for 5 common surgical procedures, and resolution of variation in opioid prescription practices after a hospital-wide intervention and statewide legislation.