Association Between Quantity of Opioids Prescribed After Surgery or Preoperative Opioid Use Education With Opioid Consumption

Abstract

Prescribing a greater quantity of opioids than needed after surgery has been associated with the development of addiction. 1 Lowering default opioid prescription quantities in an electronic medical record system has been shown to reduce the amount of opioids prescribed after surgery. 2 However , the effect of reduced prescription quantities on actual patient opioid consumption remains undetermined. Additionally , patient education may also play a role in decreasing excess postoperative opioid use. 3 We assessed whether reducing the number of opioid tablets prescribed would decrease postoperative opioid consumption, and whether preoperative opioid use education would further reduce the amount taken. Methods | All data were collected prospectively from adolescent and adult patients undergoing anterior cruciate ligament reconstruction at a single academic ambulatory surgery center as part of a quality improvement initiative. Institutional review board approval was obtained for the quality improvement initiative and the need for informed consent was waived. At the clinic visit occurring in the third post-operative week, patients completed a survey describing opioid tablets consumed, days of postoperative opioid use, and opioid-related adverse effects. Refills within 2 months were obtained from electronic medical records and the state prescription drug monitoring program. Patients were nonrandomly separated into 3 cohorts based on the date of surgery. Patients undergoing surgery between December 2016 and July 2017 were given 50 tablets of Percocet (7.5-mg oxycodone/325-mg acetaminophen; 1-2 tablets every 4-6 hours as needed). Patients undergoing surgery between August 2017 and February 2018 were given 30 tablets. From March 2018 to September 2018, scripted opioid use education was given to a cohort of patients receiving 30 tablets. The educational session, which outlined appropriate opioid use and alternative pain control strategies, was delivered by athletic trainers at the preop-erative clinic visit and the surgeon in the preoperative holding area and reinforced by nursing staff in the postoperative holding area. There were no changes in patient selection for surgery, personnel, surgical technique or materials, or anesthesia and postoperative rehabilitation protocols during these periods. The number of opioid tablets taken and the days of opi-oid use were compared between the 50-and 30-tablet (no education) groups and between the 30-tablet groups (no education vs education). Differences in categorical variables were assessed with χ 2 or Fischer exact tests. t Tests or Wilcoxon rank-sum tests were used to compare parametric and nonparametric continuous data. A 2-sided P < .05 was considered statistically significant. Analysis was performed with SPSS.