Reducing Opioid Overprescribing through Procedure-specific Prescribing Guidelines

Abstract

Despite advances in opioid-sparing pain management, postdischarge opioid overprescribing in plastic surgery remains an issue. Procedure-specific prescribing protocols have been implemented successfully in other surgical specialties but not broadly in plastic surgery. This study examined the efficacy of procedure-specific prescribing guidelines for reducing postdischarge opioid overprescribing.

Methods: A total of 561 plastic surgery patients were evaluated retrospectively after a prescribing guideline, which recommended postdischarge prescription amounts based on the type of operation, was introduced in July 2020. Prescription and postdischarge opioid consumption amounts before (n = 428) and after (n = 133) guideline implementation were compared. Patient satisfaction and prescription frequency of nonopioid analgesia were also compared.

Results: The average number of opioid pills per prescription decreased by 25% from 19.3 (27.4 OME) to 15.0 (22.7 OME; P = 0.001) after guideline implementation, with no corresponding decrease in the average number of postdischarge opioid pills consumed [10.6 (15.1 OME) to 8.2 (12.4 OME); P = 0.147]. Neither patient satisfaction with pain management (9.6-9.6; P > 0.99) nor communication (9.6-9.5; P > 0.99) changed. The rate of opioid-only prescription regimens decreased from 17.9% to 7.6% (P = 0.01), and more patients were prescribed at least two nonopioid analgesics (27.5% to 42.9%; P = 0.003). The rate of scheduled acetaminophen prescription, in particular, increased (54.7% to 71.4%; P = 0.002).

Conclusions: A procedure-specific prescribing model is a straight-forward intervention to promote safer opioid-prescribing practices in plastic surgery. Its usage in clinical practice may lead to more appropriate opioid prescribing.

Fig. 1.

Opioid-prescribing guidelines. A guide detailing recommended prescription amounts based on the type of operation undergone by the patient was distributed to physicians in the Department of Plastic and Reconstructive Surgery at The Ohio State University.

Fig. 2.

Opioid prescription and consumption. Comparison of opioid prescription (A) and post-discharge consumption amounts (B). Two-way ANOVA with Tukey post hoc test. *, <0.05; **, <0.01; ***, <0.001; ****, <0.0001; ns, not significant.

Fig. 3.

Patient satisfaction. Patient satisfaction ratings regarding pain control (A) and communication (B) remained similar across all groups. Kruskal-Wallis nonparametric tests. ns, not significant.