Presentation Authors: Hiten Patel*, Farzana Faisal, Neil Patel, Christian Pavlovich, Mohamad Allaf, Misop Han, Amin Herati, Baltimore, MD
Introduction: Opioid pain medications are overprescribed, but little data is available to appropriately tailor post-discharge opioid prescriptions after urologic surgery. The Opioid Reduction Intervention for Open, Laparoscopic, and Endoscopic Surgery (ORIOLES) initiative established an evidence-based reference value for opioid prescribing after radical prostatectomy and implemented a prospective intervention to reduce prescribing and use. The objective of the present study was to report on changes in opioid prescribing and use after intervention in the ORIOLES initiate.
Methods: A prospective, non-randomized, pre-post cohort study of patients undergoing radical prostatectomy for prostate cancer (2017-2018) as part of ORIOLES was conducted. The primary outcome was total oral morphine equivalents (OMEQ) used after surgery with a reference value set to meet the needs of >80% of patients based on the pre-intervention cohort. Surgical approach and predictors of use were assessed via multivariable linear regression and mixed effects models. The post-intervention cohort all received an informational discharge sheet on opioid medications, nursing education, and standardized prescribing based on the reference value.
Results: A total of 205 patients were included in the pre-intervention cohort and 87 patients in the post-intervention cohort. Prior to intervention, a median of 225mg OMEQ was prescribed, 22.5mg used, an overall 77% of medication unused, and 9.3% appropriate disposal of leftover medication. About 84% of patients required â‰¤112.5mg OMEQ with greater prescribing independently associated with greater opioid use in adjusted models. The post-intervention cohort demonstrated a statistically significant reduction in OMEQ prescribed (-45.5%; mean 226.5mg to 123.4mg). OMEQ used was decreased (-21.5%; mean 52.5mg to 41.2mg) with a slight increase in disposal (+7.6%; 9.3% to 16.9%) though these were not statistically significant with the current sample size. Only 6 (6.9%) patients required additional opioid medication in the post-intervention cohort.
Conclusions: Opioid pain medications are overprescribed relative to actual use by patients after radical prostatectomy with more opioids used when a greater quantity is prescribed. An appropriate baseline reference value for prescriptions after radical prostatectomy is 112.5mg OMEQ, which equates to 15 tablets of oxycodone 5 mg, with a simple prospective, evidence-based intervention associated with improved prescribing, use, and disposal.