Using restrictive opioid protocols for postsurgical pain management does not compromise patient reported outcomes

Abstract

Objectives: Opioid misuse is a public health emergency in the United States with substantial burden in morbidity and economic costs. Surgery is a known risk factor for chronic opioid use, still health care providers are often resistant to change opioid prescribing patterns due to concern for adequate postsurgical recovery and decreased patient satisfaction. In order to minimize the risk of chronic opioid use, we developed and successfully implemented restrictive opioid prescribing protocols across all surgical services at a large tertiary cancer center. We measured patient reported outcomes to evaluate whether patient satisfaction with postsurgical pain management during recovery is influenced by the amount of opioid pain medications provided in the postoperative period after hospital discharge. Methods: In this case-control cohort study, restrictive opioid prescription protocols were designed and implemented from February 1st, 2019 across all surgical services at a single tertiary-care comprehensive cancer center. In general, all patients undergoing ambulatory or minimally invasive surgery were not prescribed opioids, while patients undergoing a major open surgical procedure were provided no more than a 3-day opioid pain medication supply at the time of discharge. All outgoing prescriptions and refills were strictly monitored on a daily base and tracked and verified by the New York State Prescription Monitoring Program Registry (I-STOP) for the 30-day postoperative period an all surgical patients. Validated Patient-Reported Outcomes Measurement Information System (PROMIS) surveys were randomly implemented during postoperative visits to survey surgical patients on all surgical services 6 months prior to (08/2018-01/2019) and for 6 months after (02/2019-08/2019) the ROPPs implementation. Results: A total of 698 patients were randomly surveyed during the study period, with 338 patients in the pre-implementation cohort and 360 patients who had surgery after the ROPP was implemented and received little to no opioids following discharge. The compliance with the protocol across surgical services was 95% and the number of opioid pain medications prescribed to all surgical patients in the first 30 days of postoperative recovery was significantly decreased (p Conclusions: Our study demonstrates that implementation of restrictive opioid prescription protocols across surgical services is feasible and led to significant decrease in opioid pain medication use in the postoperative period, without compromising patient satisfaction or interfering with patient active recovery and day-day to activities after hospital discharge.