Erschienen in:
06.08.2020 | Breast Oncology
Adoption of Opioid-Sparing and Non-Opioid Regimens After Breast Surgery in a Large, Integrated Health Care Delivery System
verfasst von:
Avani R. Patel, MBBS, Brooke Vuong, MD, MHA, Gillian E. Kuehner, MD, Patience Odele, MD, Garner Low, PharmD, Alison Savitz, MD, Veronica Shim, MD, Margaret Mentakis, MD, Elizabeth Linehan, MD, Sharon B. Chang, MD, The Permanente Medical Group Breast Research Collaborative
Erschienen in:
Annals of Surgical Oncology
|
Ausgabe 12/2020
Einloggen, um Zugang zu erhalten
Abstract
Background
Postoperative prescriptions have contributed to the opioid epidemic. In response, a large, integrated health care delivery system implemented initiatives to reduce outpatient opioid prescriptions. We evaluated the impact of these interventions on opioid-prescribing practices after breast surgery.
Methods
We examined postoperative prescribing practices before and after the 2016–2018 intervention period. Primary endpoints were the use of non-opioid regimens (NORs) and morphine milligram equivalents (MMEs) prescribed for postoperative pain management, while secondary endpoints were emergency department (ED) visits and readmissions within 7 days of surgery.
Results
In a survey of breast surgeons, 23% reported using NORs in 2017 versus 79% in 2019 (p < 0.001). Comparing 1917 breast operations from 2016 with 2166 operations from 2019, NORs increased from 9% in 2016 to 39% in 2019 (p < 0.001). Average discharge MMEs per operation decreased from 190 in 2016 to 106 in 2019 (p < 0.001). NOR failure (defined as an additional opioid prescription within 2 weeks of surgery) was < 1%. Significantly fewer postoperative ED visits occurred in the NOR group (1.9% NOR vs. 3.4% opioid regimen [OR]; p < 0.001). The 7-day readmission rates for NOR and OR patients were similar (0.49% NOR vs. 0.32% OR; p = 0.45).
Conclusion
Between 2016 and 2019, breast surgeons in a large, integrated health care delivery system adopted NORs for nearly 40% of breast operations, and prescribed significantly fewer MMEs, with no increases in ED visits or readmissions for NOR patients. This suggests that initiatives to decrease opioid prescribing were successful and that a NOR for pain management after breast surgery is feasible.