Abstract
Introduction
Opioids are commonly prescribed beyond what is necessary to adequately manage postoperative
pain, increasing the likelihood of chronic opioid use, pill diversion, and misuse.
We sought to assess opioid utilization and patient-reported outcomes (PROs) in patients
undergoing ventral hernia repair (VHR) following the implementation of a patient-tailored
opioid prescribing guideline.
Methods
A patient-tailored opioid prescribing guideline was implemented in March of 2018 for
patients undergoing inpatient VHR in a large regional healthcare system. We retrospectively
assessed opioid utilization and patient-reported outcomes among patients who did (n = 42) and did not receive guideline-based care (n = 121) between March 2018 and December 2019. PROs, operative details, and patient
characteristics were extracted from the Abdominal Core Health Quality Collaborative
(ACHQC) registry data, and length-of-stay and prescription information were extracted
from the electronic health record system at the healthcare institution.
Results
The milligram morphine equivalents (MME) prescribed at discharge was lower for patients
receiving guideline-based care (Median = 65, interquartile range [IQR] = 50-75) than
patients receiving standard care (Median = 100, IQR = 60-150). After adjusting for
patient characteristics, the odds of receiving an opioid refill after discharge did
not significantly differ between patient groups (P = 0.43). Patient Reported Outcomes Measurement Information System (PROMIS) pain scores
and hernia-specific quality-of-life (HerQLes) scores at follow-up also did not differ
between patients receiving guideline-based care (Mean PROMIS = 57.3; Mean HerQLes = 53.1)
versus those that did not (Mean PROMIS = 56.7; Mean HerQLes = 46.6).
Conclusions
Patients who received tailored, guideline-based opioid prescriptions were discharged
with lower opioid dosages and did not require more opioid refills than patients receiving
standard opioid prescriptions. Additionally, we found no differences in pain or quality-of-life
scores after discharge, indicating the opioids prescribed under the guideline were
sufficient for patients.
Keywords
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Article info
Publication history
Published online: October 18, 2022
Accepted:
September 20,
2022
Received in revised form:
August 24,
2022
Received:
March 1,
2022
Identification
Copyright
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