TY - JOUR
T1 - Long-term Success With Diminished Opioid Prescribing After Implementation of Standardized Postoperative Opioid Prescribing Guidelines
T2 - An Interrupted Time Series Analysis
AU - Findlay, Bridget L.
AU - Britton, Cameron J.
AU - Glasgow, Amy E.
AU - Gettman, Matthew T.
AU - Tyson, Mark D.
AU - Pak, Raymond W.
AU - Viers, Boyd R.
AU - Habermann, Elizabeth B.
AU - Ziegelmann, Matthew J.
N1 - Publisher Copyright:
© 2020 Mayo Foundation for Medical Education and Research
PY - 2021/5
Y1 - 2021/5
N2 - Objective: To assess longitudinal prescribing patterns for patients undergoing urologic surgery in the nearly 2-year time frame before and after implementation of an evidence-based opioid prescribing guideline to accurately characterize the impact on postoperative departmental practices. Patients and Methods: Historical prescribing data for adults who underwent 21 urologic procedures at 3 academic institutions were used to derive a 4-tiered guideline for postoperative opioid prescribing. The guideline was implemented on January 16, 2018, and prescribing patterns including quantity of opioids prescribed (in oral morphine equivalents [OMEs]) and refill rates were compared for opioid-naïve patients undergoing urologic surgery before (January 1, 2016, through January 15, 2018; N=10,649) and after (January 16, 2018, through September 30, 2019; N=9422) guideline implementation. Univariate analysis was performed using Wilcoxon rank sum and χ2 tests. Cochran-Armitage trend tests and interrupted time series analysis were used to test for significance in the change in OMEs prescribed before vs after guideline implementation. Results: The median quantity of opioids decreased from 150 OMEs (interquartile range, 0-225) before guideline implementation to 0 OMEs (interquartile range, 0-90) after guideline implementation (P<.001). Median OMEs decreased significantly in each tier and each of 21 individual procedures. Overall guideline adherence was 90.7% (n=8547). Despite this decrease in OMEs prescribed, post–guideline implementation patients obtained fewer refills than the pre–guideline implementation group (614 [6.5%] vs 999 [9.4%]; P<.001). Conclusion: In a multi-institutional follow-up prospective study of adult urologic surgery–specific evidence-based guidelines for postoperative prescribing, we demonstrate sustained reduction in OMEs prescribed secondary to guideline implementation and adherence by our providers.
AB - Objective: To assess longitudinal prescribing patterns for patients undergoing urologic surgery in the nearly 2-year time frame before and after implementation of an evidence-based opioid prescribing guideline to accurately characterize the impact on postoperative departmental practices. Patients and Methods: Historical prescribing data for adults who underwent 21 urologic procedures at 3 academic institutions were used to derive a 4-tiered guideline for postoperative opioid prescribing. The guideline was implemented on January 16, 2018, and prescribing patterns including quantity of opioids prescribed (in oral morphine equivalents [OMEs]) and refill rates were compared for opioid-naïve patients undergoing urologic surgery before (January 1, 2016, through January 15, 2018; N=10,649) and after (January 16, 2018, through September 30, 2019; N=9422) guideline implementation. Univariate analysis was performed using Wilcoxon rank sum and χ2 tests. Cochran-Armitage trend tests and interrupted time series analysis were used to test for significance in the change in OMEs prescribed before vs after guideline implementation. Results: The median quantity of opioids decreased from 150 OMEs (interquartile range, 0-225) before guideline implementation to 0 OMEs (interquartile range, 0-90) after guideline implementation (P<.001). Median OMEs decreased significantly in each tier and each of 21 individual procedures. Overall guideline adherence was 90.7% (n=8547). Despite this decrease in OMEs prescribed, post–guideline implementation patients obtained fewer refills than the pre–guideline implementation group (614 [6.5%] vs 999 [9.4%]; P<.001). Conclusion: In a multi-institutional follow-up prospective study of adult urologic surgery–specific evidence-based guidelines for postoperative prescribing, we demonstrate sustained reduction in OMEs prescribed secondary to guideline implementation and adherence by our providers.
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U2 - 10.1016/j.mayocp.2020.10.045
DO - 10.1016/j.mayocp.2020.10.045
M3 - Article
C2 - 33958051
AN - SCOPUS:85105451265
SN - 0025-6196
VL - 96
SP - 1135
EP - 1146
JO - Mayo Clinic proceedings
JF - Mayo Clinic proceedings
IS - 5
ER -