J. Klugh1, M. Zhao1, N. Deboever1, M. Luciano1, D. Bavishi1, M. Font Garcia1, A. Boyev1, R. Yang1, S. Naqvi1, M. Wandling1 1University Of Texas Health Science Center At Houston, Acute Care Surgery, Houston, TX, USA
Introduction:
Around 75-90% of surgical patients receive an opioid at discharge, however, up to 70% of those prescribed pills go unused. Additionally, persistent opioid use at 90 to 180 days after surgery is as high as 13%, highlighting the importance of opioid stewardship. We hypothesized that uniform patient education and a standardized discharge pain regimen would reduce opioid prescription rates.
Methods:
Patients admitted to the emergency general surgery service undergoing laparoscopic cholecystectomy or appendectomy were included for analysis. The invention was implemented on 01/01/2024 with patients admitted from 12/1/2022 to 01/31/2023 serving as the control. The intervention included a small card, provided to patients preoperatively, with QR codes linking to the American College of Surgeons’ Safe Pain Control educational pamphlet and video. Additionally, at discharge, patients were provided prescriptions for Tylenol 1000 mg q6h for 2 weeks, Naproxen 500 mg q12h for 1 week, and five times the amount of Tramadol 50 mg the patient used in the 24-hour post-operative period up to 10 total tabs. Baseline characteristics and inpatient pain medication rates were compared. The primary outcome was rate of opioid prescription at discharge, and secondary outcomes included number of Tramadol tabs and rates of other pain medications prescriptions. Univariate analysis including Pearson's Chi-squared test and Kruskal-Wallis rank sum test were used as appropriate.
Results:
A total of 155 patients were included for analysis with 122 in the pre-protocol group and 33 in the post-protocol group at the interim analysis. No differences were seen between groups in terms of age, sex, or race. Rates of inpatient Tylenol (97% versus 82%, p = 0.03) and Naproxen (82% versus 61%, p = 0.02) were higher in the post-protocol group. Inpatient rates of Tramadol (45% versus 47%, p = 0.83), morphine milligram equivalents (7.5 [0, 15] versus 7.5 [0, 18], p = 0.71), Gabapentin, and Robaxin were similar between groups. Rates of Tramadol prescriptions and number of tabs when a prescription was received were lower in the post-protocol group (Table 1). Additionally, rates of Tylenol and Naproxen prescriptions were higher while rates of Gabapentin and Robaxin prescriptions were lower in the post-protocol group (Table 1).
Conclusion:
Patient education and a standardized discharge pain regimen were effective in reducing opioid prescriptions in emergency general surgery patients undergoing laparoscopic cholecystectomy or appendectomy. This effect was statistically significant despite the relatively low enrollment rate at the time of the interim analysis. Further re-enforcement and analysis is needed to ensure long-term implementation.