P406 - Evidence Based Guideline Reduces Opioid Prescribing after ERP Colorectal Surgery

Image or Table (Do Not add text here):

Purpose/Background: Enhanced Recovery Protocols (ERP) reduce post-operative opioid use, however, evidence-based guidelines for opioid prescribing at discharge after ERP colorectal surgery (CRS) are lacking. Previously, we analyzed inpatient opioid use and post-discharge pain control requirements in order to develop an evidence-based opioid prescribing guideline. Here, we now implement the guideline prospectively and assess its appropriateness and effectiveness. We hypothesize that this guideline reduces opioid prescriptions at discharge while still providing appropriate post-operative pain control.

Methods/Interventions: Patients undergoing ERP CRS at a single tertiary care institution were identified prospectively. At discharge, patients were prescribed oral opioid pain medications according to our prescribing guideline, based on their inpatient post operative opioid requirements. After discharge, patients were contacted by telephone and asked to complete a survey about their pain control requirements and opioid use after surgery. Manual chart review was performed to identify patient, surgery, and inpatient variables including total inpatient opioid use in morphine milligram equivalents (MME).

Results/Outcomes: Prospective data was collected from 92 patients undergoing elective ERP CRS after implementation of the prescribing guideline. 77.2% (n=71) were correctly prescribed according to the guideline. Pre-guideline and post-guideline cohorts did not significantly differ with respect to age, race, sex, surgery, indication, operative approach, or inpatient opioid requirements. After implementation of the prescribing guideline, discharge prescribing was reduced by 49.5% (Pre 74.99 MME, Post 37.85 MME; p< 0.001). 41 patients responded to telephone surveys after guideline implementation. After guideline implementation, patients reported taking fewer oxycodone pills at home compared to pre-guideline (1.39 vs 4.95; p< 0.001). There was no difference in the number of patients who felt like they required additional pain control post-guideline when compared to pre-guideline (Pre 9.8%, Post 10.0%; p=1.0). More patients reported taking non-opioid pain medication post-guideline compared to pre-guideline. Of patients surveyed post-guideline, more patients had a history of prior opioid use in comparison to those surveyed pre-guideline.

Conclusion/Discussion: An evidence-based guideline can reduce over-prescribing of opioids while adequately meeting patient’s analgesia needs after elective ERP CRS. Future work should be aimed at optimizing prescribing practices as many patients still reported using less pain medication than prescribed. Continued education for prescribers is required for successful opioid stewardship and promotion of a multimodal approach to post-operative pain control.