03.21 Reduction in General Surgery Outpatient Opioid Prescribing Practices with Standardized Guidelines

B. N. Thompson1, S. L. Adkins1, K. Howe1, J. R. Gillen1  1Virginia Tech Carilion School of Medicine, Carilion Clinic, Department Of Surgery, Roanoke, VA, USA


The opioid epidemic has instigated widespread re-evaluation of opioid prescribing practices. The purpose of this study was to evaluate the impact of new electronic medical record (EMR) order sets on current general surgery opioid prescribing practices. We hypothesize that with implementation of standardized guidelines, a reduction in opioid prescribing can be achieved.


This is a single institution prospective cohort study of patients ages 18-89 who underwent inpatient general surgery with length of stay (LOS) < 2 days between October 2018 and March 2021. Cohorts pre- and post- implementation of standardized postoperative EMR order sets in October 2020 were compared. Procedure specific guidelines for prescribed opioids in morphine milligram equivalents (MME) were recommended. Primary outcome assessed was discharge MME. Cohort comparisons were performed with Chi-square analysis. Threshold for significance was considered p<0.005 after Bonferroni adjustment.


There was no difference in baseline characteristics of pre- (n=5098) and post-intervention (n=1113) cohorts (Table 1). There was a significant reduction in discharge MME post intervention (70.11 vs 86.49, p<0.0001) without associated increase in opioid refills.


Surgery patients represent a vulnerable population in the present opioid epidemic. Implementation of EMR order sets maximizing nonopioid analgesia was associated with decreased postoperative opioid utilization. Utilizing procedure specific opioid prescribing guidelines for outpatient general surgery can further optimize surgeon opioid prescribing practices.