Postoperative opioid protocol: A 5-year resident-led effort to standardize prescribing patterns

• Published in: American journal of otolaryngology 2023-03, Vol.44 (2), p.103752-103752, Article 103752
• Main Authors: Meyer, Charles, Bresslour-Rashap, Élan, Winters, Jessica, Riddick, Jeanelle Braxton, Folsom, Craig, Jardine, Dinchen
• Format: Article
• Language: English
• Subjects: Adult; Analgesics, Opioid - therapeutic use; Drug Prescriptions - statistics & numerical data; Female; Humans; Internship and Residency; Male; Opioid management; Otolaryngology; Pain, Postoperative - drug therapy; Practice Patterns, Physicians' - statistics & numerical data; Quality improvement; Retrospective Studies; Standardization
• ISSN: 0196-0709; 1532-818X
• DOI: 10.1016/j.amjoto.2022.103752

The combined impact of variable surgeon prescribing preferences and low resident prescribing comfort level can lead to significant disparity in opioid prescribing patterns. We report an update on the expanded scope of this now 5-year, resident led initiative to standardize postoperative prescription practices within the Department of Otolaryngology. With Institutional Review Board approval, performed a retrospective review of 12 months before (July 2016 – June 2017) and 48 months after (July 2019–June 2021) implementation of the Expanded Postoperative Analgesia Protocol. The Pre-Protocol and Expanded Protocol cohorts were compared using ANOVA, chi-squared and Fisher Exact tests, with ANCOVA and binary logistic regression for covariate analysis. Cost impact was calculated using average medication spending data for 2018–2019. 470 patients were included in the Pre-Protocol cohort (54 % male, mean age 35 years) and 679 in the Expanded Protocol cohort (63 % male, mean age 36 years). The protocol was effectively implemented as reflected in the reduction of combination opioid medications from 429 (91.3 %) to 26 (3.8 %) (87 % reduction, 95 % CI 86 % to 89 %, p