Implementation of a Patient-Tailored Opioid Prescribing Guideline in Ventral Hernia Surgery

• Published in: The Journal of surgical research 2023-02, Vol.282, p.109-117
• Main Authors: Lindros, Sydney H., Warren, Jeremy A., Carbonell, Alfredo M., Cobb, William S., Floyd, Sarah B.
• Format: Article
• Language: English
• Subjects: Analgesic; Analgesics, Opioid - therapeutic use; Guideline-based care; Hernia, Ventral - surgery; Humans; Opioid; Pain, Postoperative - drug therapy; Pain, Postoperative - etiology; Patient-reported outcomes; Practice Patterns, Physicians; Retrospective Studies; Ventral hernia repair
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2022.09.021

Opioids are commonly prescribed beyond what is necessary to adequately manage postoperative pain, increasing the likelihood of chronic opioid use, pill diversion, and misuse. We sought to assess opioid utilization and patient-reported outcomes (PROs) in patients undergoing ventral hernia repair (VHR) following the implementation of a patient-tailored opioid prescribing guideline. A patient-tailored opioid prescribing guideline was implemented in March of 2018 for patients undergoing inpatient VHR in a large regional healthcare system. We retrospectively assessed opioid utilization and patient-reported outcomes among patients who did (n = 42) and did not receive guideline-based care (n = 121) between March 2018 and December 2019. PROs, operative details, and patient characteristics were extracted from the Abdominal Core Health Quality Collaborative (ACHQC) registry data, and length-of-stay and prescription information were extracted from the electronic health record system at the healthcare institution. The milligram morphine equivalents (MME) prescribed at discharge was lower for patients receiving guideline-based care (Median = 65, interquartile range [IQR] = 50-75) than patients receiving standard care (Median = 100, IQR = 60-150). After adjusting for patient characteristics, the odds of receiving an opioid refill after discharge did not significantly differ between patient groups (P = 0.43). Patient Reported Outcomes Measurement Information System (PROMIS) pain scores and hernia-specific quality-of-life (HerQLes) scores at follow-up also did not differ between patients receiving guideline-based care (Mean PROMIS = 57.3; Mean HerQLes = 53.1) versus those that did not (Mean PROMIS = 56.7; Mean HerQLes = 46.6). Patients who received tailored, guideline-based opioid prescriptions were discharged with lower opioid dosages and did not require more opioid refills than patients receiving standard opioid prescriptions. Additionally, we found no differences in pain or quality-of-life scores after discharge, indicating the opioids prescribed under the guideline were sufficient for patients.