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Description and Impact of a Comprehensive Multispecialty Multidisciplinary Intervention to Decrease Opioid Prescribing in Surgery

Kaafarani, Haytham M. A. MD, MPH; Eid, Ahmed I. MD; Antonelli, Donna M. BS, CPHQ; Chang, David C. PhD, MPH, MBA; Elsharkawy, Ahmed E. MD; Elahad, Joana Abed BS; Lancaster, Elizabeth A. MBA; Schulz, John T. MD; Melnitchouk, Serguei I. MD, MPH; Kastrinakis, William V. MD; Hutter, Matthew M. MD, MPH; Masiakos, Peter T. MD; Colwell, Amy S. MD; Wright, Cameron D. MD; Lillemoe, Keith D. MD

doi: 10.1097/SLA.0000000000003462

Introduction: Diversion of excess prescription opioids contributes to the opioid epidemic. We sought to describe and study the impact of a comprehensive departmental initiative to decrease opioid prescribing in surgery.

Methods: A multispecialty multidisciplinary initiative was designed to change the culture of postoperative opioid prescribing, including: consensus-built opioid guidelines for 42 procedures from 11 specialties, provider-focused posters displayed in all surgical units, patient opioid/pain brochures setting expectations, and educational seminars to residents, advanced practice providers, residents and nurses. Pre- (April 2016–March 2017) versu post-initiative (April 2017–May 2018) analyses of opioid prescribing at discharge [median oral morphine equivalent (OME)] were performed at the specialty, prescriber, patient, and procedure levels. Refill prescriptions within 3 months were also studied.

Results: A total of 23,298 patients were included (11,983 pre-; 11,315 post-initiative). Post-initiative, the median OME significantly decreased for 10 specialties (all P values < 0.001), the percentage of patients discharged without opioids increased from 35.7% to 52.5% (P < 0.001), and there was no change in opioids refills (0.07% vs 0.08%, P = 0.9). Similar significant decreases in OME were observed when the analyses were performed at the provider and individual procedure levels. Patient-level analyses showed that the preinitiative race/sex disparities in opioid-prescribing disappeared post-initiative.

Conclusion: We describe a comprehensive multi-specialty intervention that successfully reduced prescribed opioids without increase in refills and decreased sex/race prescription disparities.

Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.

The authors report no conflicts of interest.

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