Presentation Authors: Brian Linder*, John Occhino, Christopher Klingele, Emanuel Trabuco, John Gebhart, Rochester, MN
Introduction: There is increasing concern regarding the volume of opioid medications prescribed postoperatively, and the rate of prescription opioid related adverse-events. However, data regarding patient&[prime]s postoperative opioids needs following surgery for pelvic organ prolapse are sparse. To better understand and potentially improve opioid stewardship in women undergoing prolapse surgery in our practice, we evaluated patient&[prime]s actual postoperative requirements and implemented procedure-specific opioid prescribing recommendations based on these findings. We then evaluated the impact of these changes on opioid prescribing, use, pain control, and patient satisfaction.
Methods: We prospectively evaluated opioid prescribing patterns, patient utilization, medication refills, and patient satisfaction in women undergoing prolapse surgery (i.e. vaginal, abdominal, or robotic) during an eight-month time-period. Two cohorts of women, stratified by whether they had surgery before or after implementation of procedure-specific tiered opioid prescribing recommendations, were evaluated. Postoperative opioid usage (assessed via pill count) and satisfaction with pain management after hospital dismissal were evaluated by telephone call two weeks after surgery. Postoperative opioid prescribing and use were recorded after conversion to Oral Morphine Equivalents (OME).
Results: Overall, 96 women were included, 57 in the initial baseline cohort, and 39 following implementation of the prescribing recommendations. In the initial cohort, 3607/11007 mg (32.8%) of the prescribed OME were consumed. Following implementation of the prescribing recommendations, median OME prescribed decreased from 200 mg OME (IQR 150,225) to 112.5 mg OME (IQR 22.5,112.5; p < 0.0001). The total OME prescribed decreased by 45% when compared with the volume that would have been prescribed before implementing the recommendations. The amount of leftover opioids per patient significantly decreased as well (p < 0.0001). Pain medication refills increased after the intervention (18% vs 3.5%; p=0.03), while satisfaction scores were similar in both cohorts (p=0.87).
Conclusions: At baseline, overprescribing of opioids following pelvic organ prolapse surgery was common. By utilizing procedure-specific opioid prescribing recommendations we decreased the number of opioids prescribed at hospital dismissal by roughly half. Decreased opioid prescribing did not adversely impact patient satisfaction.
Source of Funding: Mayo Clinic Values Council from the Rochester Sisters of Saint Francis