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. 2023 Jul;169(1):176-184.
doi: 10.1177/01945998221121626. Epub 2023 Jan 29.

Optimization of Opioid Discharge Prescriptions Following Thyroid and Parathyroid Surgery

Elsie Rizk  1   2 , Fangzheng Yuan  1   2 , Feibi Zheng  2 , Ezekiel Fink  3 , Navjot Kaur  1   2 , Anh Thu Tran  1   2 , Tomona Iso  1   2 , Nadia G Mohyuddin  4 , Apurva A Thekdi  4 , Gilchrist L Jackson  2 , Matthew A Wanat  1   5 , J Douglas Thornton  5 , Joshua T Swan  1   2   6
Affiliations

Optimization of Opioid Discharge Prescriptions Following Thyroid and Parathyroid Surgery

Elsie Rizk et al. Otolaryngol Head Neck Surg. 2023 Jul.

Abstract

Objective: To evaluate the impact of a quality improvement bundle on opioid discharge prescribing following thyroidectomy and parathyroidectomy.

Methods: This before-and-after study included patients undergoing thyroidectomy or parathyroidectomy at an academic medical center. The quality improvement bundle included a patient education flyer, electronic health record order sets with multimodal analgesia regimens, and provider education. The preimplementation cohort included patients treated from January 2018 to December 2019. The postimplementation cohort included patients treated from June 2021 to August 2021. The primary outcome was the proportion of patients who received new opioid discharge prescriptions.

Results: A total of 160 patients were included in the preimplementation cohort, and the first 80 patients treated after bundle implementation were included in the postimplementation cohort. Patients receiving new opioid discharge prescriptions decreased from 80% (128/160) in the preimplementation cohort to 35% (28/80) in the postimplementation cohort with an unadjusted absolute reduction of 45% (95% CI, 33%-57%; P < .001; number needed to treat = 3) and an adjusted odds ratio (OR) of 0.08 (95% CI, 0.04-0.19; P < .001). The bundle was associated with reductions in opioid discharge prescriptions that exceeded 112.5 oral morphine milligram equivalents (33% pre- vs 10% postimplementation; adjusted OR, 0.20; P = .001) or 5 days of therapy (17% pre- vs 6% postimplementation; adjusted OR, 0.34; P = .049).

Discussion: Implementation of a pain management quality improvement bundle reduced opioid discharge prescribing following thyroidectomy and parathyroidectomy.

Implications for practice: Unnecessary opioid prescriptions generate unused opioids in patients' homes that can lead to opioid misuse. We believe that this bundle reduced the risk for opioid misuse in our community.

Registration: The study was registered at ClinicalTrials.gov (NCT04955444) before implementation.

Keywords: opioid stewardship; opioids; pain management; parathyroidectomy; patient safety/quality improvement; thyroidectomy.

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References

    1. Inciardi JA, Surratt HL, Kurtz SP, Cicero TJ. Mechanisms of prescription drug diversion among drug-involved club- and street-based populations. Pain Med. 2007;8(2):171-183.
    1. Neuman MD, Bateman BT, Wunsch H. Inappropriate opioid prescription after surgery. Lancet. 2019;393(10180):1547-1557.
    1. Ladha KS, Patorno E, Huybrechts KF, Liu J, Rathmell JP, Bateman BT. Variations in the use of perioperative multimodal analgesic therapy. Anesthesiology. 2016;124(4):837-845.
    1. Rizk E, Swan JT, Cheon O, et al. Quality indicators to measure the effect of opioid stewardship interventions in hospital and emergency department settings. Am J Health Syst Pharm. 2019;76(4):225-235.
    1. Ruffolo LI, Jackson KM, Juviler P, et al. Narcotic free cervical endocrine surgery: a shift in paradigm. Ann Surg. 2021;274(2):e143-e149.

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