Restrictive opioid prescription protocol feasible for most patients after cancer surgery
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Key findings:
- Nealy all patients complied with a restrictive opioid prescription protocol, resulting in a 45% reduction of opioids prescribed after surgery.
- Conversion rates to chronic opioid use decreased significantly after implementation of the protocol.
A restrictive opioid prescription protocol of 3 days or less after hospital discharge appeared feasible among a cohort of patients who underwent surgery at a large cancer center, according to study results published in JAMA Oncology.
The restrictive opioid prescription protocol could lead to decreased chronic opioid use, researchers concluded.
Background and methods
Emese Zsiros, MD, PhD, FACOG, assistant professor of oncology in the department of gynecologic oncology at Roswell Park Comprehensive Cancer Center, and colleagues sought to examine whether postsurgical acute pain could be effectively managed with a restrictive opioid prescription protocol that provided a supply of 3 days or less after hospital discharge and whether the protocol would lead to reduced opioid use.
The prospective case-control study included 4,068 patients (mean age, 61 years; 62.1% women) who underwent surgery at a tertiary-care comprehensive cancer center between August 2018 and August 2019. Researchers assigned patients to either a pre-restrictive opioid prescription protocol (n = 2,017) or a post-restrictive opioid prescription protocol (n = 2,051).
The compliance rate of the restrictive opioid prescription protocol, mean number of prescription days and refill requests, type of opioid prescribed and rate of conversion to chronic opioid use determined via a state-run opioid prescription program served as main outcomes. Researchers additionally measured postsurgical complications.
Results
Researchers reported a 95% compliance rate with the restrictive opioid prescription protocol and a 45% decrease in opioids prescribed after surgery, from a mean 157.22 morphine milligram equivalents before the protocol to 83.54 morphine milligram equivalents after the protocol (P < .001).
In addition, mean opioid prescription days decreased from 3.9 days among the pre- restrictive opioid prescription protocol group to 1.9 days in the post- restrictive opioid prescription protocol group (P < .001).
Patients assigned to the post-restrictive opioid prescription protocol group requested fewer refills compared with the pre-restrictive opioid prescription protocol group (17.9% vs. 20.9%; P = .02).
Of note, researchers observed no significant difference in surgical complication rates.
Results further showed a decrease in the conversion rate to chronic opioid use after implementation of the restrictive opioid prescription protocol among both opioid-naive patients with cancer, from 11.3% to 4.5% (P < .001), and those without cancer, from 6.1% to 2.7% (P = .02).
Limitations of the study included the single-cancer center experience, with results specifically reflecting that of western New York, and the lack of data on postsurgical adjuvant treatment.
Implications
“Changes in established clinical practices can be a daunting prospect, and unlearning conventional, anecdotal wisdom may be difficult,” Zsiros and colleagues wrote. “Our findings suggest that success at reducing opioid prescribing on an institutional level is possible through interprofessional collaborations, simple guidelines and regular feedback on performance to establish a high-quality postsurgical recovery strategy, and may be associated with decreased risk for unintended, long-term complications from opioid use.”
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