TY - JOUR
T1 - Prospective Implementation of Standardized Post-Hepatectomy Care Pathways to Reduce Opioid Prescription Volume after Inpatient Surgery
AU - Diperi, Timothy P.
AU - Newhook, Timothy E.
AU - Arvide, Elsa M.
AU - Dewhurst, Whitney L.
AU - Bruno, Morgan L.
AU - Chun, Yun Shin
AU - Tran Cao, Hop S.
AU - Lee, Jeffrey E.
AU - Vauthey, Jean Nicolas
AU - Tzeng, Ching Wei D.
N1 - Publisher Copyright:
© 2022 by the American College of Surgeons.
PY - 2022/7/1
Y1 - 2022/7/1
N2 - Background: Among the goals of prospectively implemented post-hepatectomy care pathways was a focus on patient-centric opioid reduction. We sought to evaluate the impact of pathway implementation on opioid volumes in the last 24-hour period and discharge prescriptions. Study Design: This is a retrospective cohort study comparing a prospective cohort ("POST,"September 2019 through February 2020) treated after pathway implementation to a historical cohort of hepatectomy patients ("PRE,"March 2016 through December 2017) before our 2018 departmental opioid reduction efforts. Opioid volumes in the last 24 hours and prescribed at discharge were converted to oral morphine equivalents (OME) and compared between cohorts. Results: There were 276 PRE and 100 POST patients. There was a similar proportion of major (PRE-34.1% vs POST-40%) and minimally invasive hepatectomies (PRE-19.9% vs POST-11%, p = 0.122). Implementation was associated with a shorter length of stay (median 5 d PRE vs 4 d POST, p < 0.001). Standardized opioid weaning was associated with a lower median last 24-hour OME (20 mg PRE vs 10 mg POST, p = 0.001). Using a standardized discharge calculation, median discharge OME were lower (200 mg PRE vs 50 mg POST, p < 0.001). More POST patients were discharged opioid-free (6.9% PRE vs 21% POST, p < 0.001). Conclusions: Implementation of post-hepatectomy care pathways was associated with a 50% reduction in last 24-hour OME, which, combined with a standardized discharge calculation, was associated with an overall 75% reduction in discharge opioid volumes and tripled opioid-free discharges. These data suggest that no-cost, reproducible pathways can be considered in abdominal operations with similar incisions/length of stay to decrease variation in opioid dosing while prioritizing patient-centric opioid needs.
AB - Background: Among the goals of prospectively implemented post-hepatectomy care pathways was a focus on patient-centric opioid reduction. We sought to evaluate the impact of pathway implementation on opioid volumes in the last 24-hour period and discharge prescriptions. Study Design: This is a retrospective cohort study comparing a prospective cohort ("POST,"September 2019 through February 2020) treated after pathway implementation to a historical cohort of hepatectomy patients ("PRE,"March 2016 through December 2017) before our 2018 departmental opioid reduction efforts. Opioid volumes in the last 24 hours and prescribed at discharge were converted to oral morphine equivalents (OME) and compared between cohorts. Results: There were 276 PRE and 100 POST patients. There was a similar proportion of major (PRE-34.1% vs POST-40%) and minimally invasive hepatectomies (PRE-19.9% vs POST-11%, p = 0.122). Implementation was associated with a shorter length of stay (median 5 d PRE vs 4 d POST, p < 0.001). Standardized opioid weaning was associated with a lower median last 24-hour OME (20 mg PRE vs 10 mg POST, p = 0.001). Using a standardized discharge calculation, median discharge OME were lower (200 mg PRE vs 50 mg POST, p < 0.001). More POST patients were discharged opioid-free (6.9% PRE vs 21% POST, p < 0.001). Conclusions: Implementation of post-hepatectomy care pathways was associated with a 50% reduction in last 24-hour OME, which, combined with a standardized discharge calculation, was associated with an overall 75% reduction in discharge opioid volumes and tripled opioid-free discharges. These data suggest that no-cost, reproducible pathways can be considered in abdominal operations with similar incisions/length of stay to decrease variation in opioid dosing while prioritizing patient-centric opioid needs.
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U2 - 10.1097/XCS.0000000000000231
DO - 10.1097/XCS.0000000000000231
M3 - Article
C2 - 35703961
AN - SCOPUS:85132080699
SN - 1072-7515
VL - 235
SP - 41
EP - 48
JO - Journal of the American College of Surgeons
JF - Journal of the American College of Surgeons
IS - 1
ER -