Opioid Prescriber Education and Guidelines Decreases Opioids Prescribed after Ambulatory Hand Surgery
Jeffrey Stepan, MD, MSc; Francis C Lovecchio, MD; Ajay Premkumar, MD, MPH; Michael C Fu, MD, MHS; Hayley A Sacks, BA; Duretti T Fufa, MD; Daniel A Osei, MD, MSc; Hospital for Special Surgery, New York, NY
Recent studies demonstrate a consistent over prescription of opioids after ambulatory hand surgery. Prescriber education, however, has been shown to decrease these practices on a small scale. Currently, there are no national, standardized opioid prescriber education materials or prescribing guidelines for ambulatory hand surgery. The purpose of this study is to evaluate the effect of opioid education and prescribing guidelines on opioid prescribing practices after ambulatory hand surgery.
Materials and Methods
This retrospective study was performed at an academic orthopedic hospital, which mandated a one-hour opioid education program in November 2016 for all clinical employees. Prescribing guidelines were formulated based on literature and disseminated in February 2017. Guidelines were stratified into three categories based on procedure-associated morbidity (Table 1). We reviewed postoperative opioid prescriptions for patients that underwent ambulatory hand surgery two months prior to the mandatory education, two months after the education, and two months after the dissemination of guidelines. Exclusion criteria were procedures not specified in the guidelines and long acting opioid use. All prescriptions were converted to total morphine milligram equivalents (MME) for comparison. We used Kruskal-Wallis non-parametric tests to compare MME during these three time periods stratified by level of surgery.
731 ambulatory hand surgeries with postoperative opioid prescriptions met criteria. All three time periods had a similar ratio of types of surgeries performed (p=0.25). On average, there was a 45% reduction (decrease of 86.2 MME per procedure = 17 five mg hydrocodone pills) in total MME per procedure after teaching and dissemination of guidelines (Figure 1). There was also a statistically significant decrease in the amount of opioids prescribed when stratifying by surgery level and by procedures with >70 cases over the study period (Table 2).
Mandatory prescriber education and the dissemination of prescribing guidelines led to significant decreases in opioids prescribed after ambulatory hand surgery. Similar programs should be implemented and will likely reduce the amount of opioids prescribed after ambulatory hand surgery in other settings.
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