G. Jenkins1, D. Oyler1, R. Randle2, C. Lee2, D. Sloan2 1University Of Kentucky,College Of Pharmacy,Lexington, KY, USA 2University Of Kentucky,College Of Medicine,Lexington, KY, USA
Introduction: The opioid epidemic is a major public health crisis in the United States, particularly in Kentucky. For most individuals, initial exposure to opioids comes from an interaction with the healthcare system, and multiple publications have highlighted the overprescription of opioids in ambulatory surgeries. In February 2018, the UK HealthCare general surgery department implemented an opioid-sparing analgesia protocol for patients undergoing thyroid and parathyroid surgery. The objective of this project was to evaluate this protocol to understand its effectiveness and prescriber compliance.
Methods: Patients undergoing thyroid or parathyroid surgery (CPT code 60220, 60240, 60271, or 60500) between May and October of 2017 (control) or 2018 (intervention) were eligible for inclusion. Effectiveness of the protocol was measured by analysis of postoperative prescription characteristics, including frequency of opioid prescriptions, morphine milligram equivalents (MMEs) per prescription, and duration of opioid use pre- and post-protocol implementation.
Results: A total of 525 patients were enrolled in the study, 243 in the control group and 282 in the intervention group. Patients in the intervention group were less likely to be on chronic opioid therapy preoperatively (2.8 vs. 12.3%, p<0.001) and were less likely to have underwent thyroidectomy (36.9 vs. 44.4%, p=0.027). There were no other statistically significant differences between groups at baseline. Patients in the intervention group were less likely to be prescribed an opioid postoperatively (11.7 vs. 58.8%, p<0.001). Patients who were opioid-naïve preoperatively were also less likely to receive a postoperative opioid in the intervention group (10.2 vs. 59.6%, p<0.001). Patients prescribed opioids in the intervention cohort were given lower doses for shorter periods of time, but these difference were not statistically significant. Full results are described in Table 1.
Conclusion: Implementation of an opioid-sparing protocol dramatically reduced the number of patients prescribed an opioid analgesic after thyroid or parathyroid surgery. Further research is warranted to evaluate the impact on patient-reported analgesia.
