TY - JOUR
T1 - Opioid Discharge Prescriptions After Inpatient Surgery
T2 - Risks of Rebound Refills by Length of Stay
AU - DiPeri, Timothy P.
AU - Newhook, Timothy E.
AU - Tran Cao, Hop S.
AU - Ikoma, Naruhiko
AU - Dewhurst, Whitney L.
AU - Arvide, Elsa M.
AU - Bruno, Morgan L.
AU - Katz, Matthew H.G.
AU - Vauthey, Jean Nicolas
AU - Lee, Jeffrey E.
AU - Tzeng, Ching Wei D.
N1 - Funding Information:
Dr DiPeri is supported by the National Institutes of Health T32 CA 009599 and the MD Anderson Cancer Center support grant (P30 CA016672). Dr Tzeng is supported by the University Cancer Foundation and the Duncan Family Institute for Cancer Prevention and Risk Assessment via a Cancer Survivorship Research Seed Money Grant at the University of Texas MD Anderson Cancer Center and an Andrew Sabin Family Foundation Fellowship.
Funding Information:
We would like to thank our Complex General Surgical Oncology, Surgical Endocrinology, Colorectal, and Hepatopancreatobiliary fellows for their outstanding patient care and participation in our opioid reduction efforts. We would like to thank the multidisciplinary partners within our “Perioperative Reduction in Opioids through Multidisciplinary Options, Trials, and Education” (PROMOTE) Consortium.
Publisher Copyright:
© 2022 Elsevier Inc.
PY - 2022/10
Y1 - 2022/10
N2 - Introduction: As inpatient stays become shorter, one concern with standardizing discharge opioid prescriptions is the potential risk of “rebound refills.” We sought to compare opioid prescription refill rates and volumes for surgical patients discharged on postoperative day (POD) 2-3, 4-7, and 8+. Methods: In a prospective quality improvement protocol, faculty volunteered to use either a 5x-multiplier (5x) or usual care (UC) for discharge prescriptions after inpatient (≥48 h stay) surgery from Sep-Dec 2019. The 5x-multiplier is 5-times the patient's last 24-h opioid use (by oral morphine equivalents, OME). Cohorts were compared by POD of discharge: POD 2-3 (“SHORT”), POD 4-7 (“INTERMEDIATE”), and POD 8+ (“LONG”). The primary endpoint was 30-d refill rates. Secondary endpoints included 30-d refill OME and inpatient opioid weaning/discharge metrics. Results: From 22 faculty, 409 patients were included. When stratified by POD, 154 (37.7%) were discharged SHORT, 176 (43.0%) INTERMEDIATE, and 79 (19.3%) LONG. SHORT stay patients had a median last 24-h OME of 10 mg (versus 5 mg INTERMEDIATE, 5 mg LONG; P = 0.268), and a median discharge OME of 55 mg (versus 75 mg INTERMEDIATE, 100 mg LONG; P = 0.221). Patients with SHORT stays did not have higher refill rates (11.7% versus 18.2% INTERMEDIATE, 19.0% LONG; P = 0.193) or higher median refill OME (150 mg versus 300 mg INTERMEDAITE, 339 mg LONG; P = 0.154). Conclusions: Despite concerns of increased refills, patients discharged by POD 2-3 were not associated with “rebound refills.” A patient-centered 5x-multiplier standardization of discharge opioid prescriptions is feasible in all inpatient surgery patients, even those discharged following a short inpatient stay.
AB - Introduction: As inpatient stays become shorter, one concern with standardizing discharge opioid prescriptions is the potential risk of “rebound refills.” We sought to compare opioid prescription refill rates and volumes for surgical patients discharged on postoperative day (POD) 2-3, 4-7, and 8+. Methods: In a prospective quality improvement protocol, faculty volunteered to use either a 5x-multiplier (5x) or usual care (UC) for discharge prescriptions after inpatient (≥48 h stay) surgery from Sep-Dec 2019. The 5x-multiplier is 5-times the patient's last 24-h opioid use (by oral morphine equivalents, OME). Cohorts were compared by POD of discharge: POD 2-3 (“SHORT”), POD 4-7 (“INTERMEDIATE”), and POD 8+ (“LONG”). The primary endpoint was 30-d refill rates. Secondary endpoints included 30-d refill OME and inpatient opioid weaning/discharge metrics. Results: From 22 faculty, 409 patients were included. When stratified by POD, 154 (37.7%) were discharged SHORT, 176 (43.0%) INTERMEDIATE, and 79 (19.3%) LONG. SHORT stay patients had a median last 24-h OME of 10 mg (versus 5 mg INTERMEDIATE, 5 mg LONG; P = 0.268), and a median discharge OME of 55 mg (versus 75 mg INTERMEDIATE, 100 mg LONG; P = 0.221). Patients with SHORT stays did not have higher refill rates (11.7% versus 18.2% INTERMEDIATE, 19.0% LONG; P = 0.193) or higher median refill OME (150 mg versus 300 mg INTERMEDAITE, 339 mg LONG; P = 0.154). Conclusions: Despite concerns of increased refills, patients discharged by POD 2-3 were not associated with “rebound refills.” A patient-centered 5x-multiplier standardization of discharge opioid prescriptions is feasible in all inpatient surgery patients, even those discharged following a short inpatient stay.
KW - 5x-multiplier
KW - Enhanced recovery
KW - Morphine
KW - Narcotics
KW - Quality improvement
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U2 - 10.1016/j.jss.2022.04.057
DO - 10.1016/j.jss.2022.04.057
M3 - Article
C2 - 35597025
AN - SCOPUS:85133916001
SN - 0022-4804
VL - 278
SP - 111
EP - 118
JO - Journal of Surgical Research
JF - Journal of Surgical Research
ER -