D. Livingston-Rosanoff1, B. Rademacher1, E. Lawson1 1University Of Wisconsin,Colorectal Surgery,Madison, WI, USA
Introduction: Overprescribing of opioids by surgeons contributes to the opioid epidemic by putting patients at risk of new opioid dependence and creating a supply of opioids that may be diverted into the community with the potential for misuse. The objective of our study was to determine if implementation of standardized recommendations for opioid prescribing would result in a decreased quantity of pills prescribed at discharge for patients undergoing colectomy or diverting loop ileostomy reversal. In addition, we sought to determine if our set recommendations were sufficient or excessive, as measured by number of pills consumed by patients and need for refills.
Methods: In September 2017, standardized recommendations for the quantity of 5mg oxycodone pills prescribed at discharge were implemented for patients undergoing colectomy (40 pills) and diverting loop ileostomy reversal (20 pills) on a colorectal surgery service in an academic center. Prescribing habits before and after implementation were compared by recording the quantity of pills prescribed to patients and frequency of refills between April-May 2017 (before implementation) and between April-May 2018 (after implementation). Use of post-discharge opioids in 2018 was quantified through a survey administered at the postoperative follow-up clinic visit.
Results: 43 patients in 2017 and 45 patients in 2018 underwent colectomy, while 25 patients in 2017 and 21 patients in 2018 underwent ileostomy reversal. From 2017 to 2018, the median number of pills prescribed at discharge decreased from 30 (range 10-80) to 20 (range 5-90) for colectomy and from 30 (range 10-75) to 25 (range 10-60) for ileostomy reversal. There was no change in the number of colectomy patients seeking refills (2% vs 0%, p=0.114), but there was an increase in refills among patients undergoing ileostomy reversal (4% vs 29%, p=0.014). The clinic survey was completed by 20 colectomy and 10 ileostomy reversal patients in 2018. Almost half of patients did not fill their opioid prescription at discharge (45% colectomy, 40% ileostomy reversal). Of patients who did fill their prescription, many used fewer than 5 pills (45% colectomy, 33% ileostomy reversal).
Conclusion: Implementation of standardized recommendations for opioid prescriptions at discharge was associated with a decrease in the median number of pills prescribed for patients undergoing colectomy or ileostomy reversal. There is variation in the use of opioids after discharge, especially for patients undergoing ileostomy reversal, with some patients requesting refills while other patients take few or no opioids at all. Better predictive strategies and reinforcement of standardized recommendations are needed to further decrease overprescribing of opioids at discharge.