The Standardization of Outpatient Procedure (STOP) Narcotics: A Prospective Health Systems Intervention to Reduce Opioid Use in Ambulatory Breast Surgery
Background During the past 15 years, opioid-related overdose death rates for women have increased 471%. Many surgeons provide opioid prescriptions well in excess of what patients actually use. This study assessed a health systems intervention to control pain adequately while reducing opioid prescrip...
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| Veröffentlicht in: | Annals of surgical oncology 2019-10, Vol.26 (10), p.3295-3304 |
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| container_title | Annals of surgical oncology |
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| creator | Hartford, Luke B. Van Koughnett, Julie Ann M. Murphy, Patrick B. Knowles, Sarah A. Wigen, Robin B. Allen, Laura J. Clarke, Collin F. M. Brackstone, Muriel Gray, Daryl K. Maciver, Allison H. |
| description | Background
During the past 15 years, opioid-related overdose death rates for women have increased 471%. Many surgeons provide opioid prescriptions well in excess of what patients actually use. This study assessed a health systems intervention to control pain adequately while reducing opioid prescriptions in ambulatory breast surgery.
Methods
This prospective non-inferiority study included women 18–75 years of age undergoing elective ambulatory general surgical breast procedures. Pre- and postintervention groups were compared, separated by implementation of a multi-pronged, opioid-sparing strategy consisting of patient education, health care provider education and perioperative multimodal analgesic strategies. The primary outcome was average pain during the first 7 postoperative days on a numeric rating scale of 0–10. The secondary outcomes included medication use and prescription renewals.
Results
The average pain during the first 7 postoperative days was non-inferior in the postintervention group despite a significant decrease in median oral morphine equivalents (OMEs) prescribed (2.0/10 [100 OMEs] pre-intervention vs 2.1/10 [50 OMEs] post-intervention;
p
= 0.40 [
p
|
| doi_str_mv | 10.1245/s10434-019-07539-w |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2288011479</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2263021521</sourcerecordid><originalsourceid>FETCH-LOGICAL-c375t-f853459eacc6aedb7ae7bd479c3e3b8c97d79ee2aa30c9a3a94451dde55c6bc3</originalsourceid><addsrcrecordid>eNp9kctu1DAUhi0EoqXwAiyQJTZlEepLHMfshgraSlWnYoa15dhnqKskDrbTangT3rYepoDEgpUv5_Nn-_wIvabkPWW1OEmU1LyuCFUVkYKr6v4JOqSibNVNS5-WOWnaSrFGHKAXKd0SQiUn4jk64JTXjEt6iH6ubwCvshmdic7_MNmHEYcNXs55KgsYM76OwYKbI-Dj1Xp5_Q5fmWhD9jZ9wItdNU1gs78DfA6mzzd4tU0ZhoQvxgzxrih2zhzwl2KxgJeTD97hrwmwH_Fi6Obe5BC3-GMEkzJezfEbxO1L9Gxj-gSvHscjtP78aX16Xl0uzy5OF5eV5VLkatOWDwsFxtrGgOukAdm5WirLgXetVdJJBcCM4cQqw42qa0GdAyFs01l-hI732imG7zOkrAefLPS9GSHMSTPWtoTSIizo23_Q2zDHsTyuUA0njApGC8X2lC2dSRE2eop-MHGrKdG73PQ-N11y079y0_fl0JtH9dwN4P4c-R1UAfgeSKU0lv78vfs_2gcjiKZ2</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2263021521</pqid></control><display><type>article</type><title>The Standardization of Outpatient Procedure (STOP) Narcotics: A Prospective Health Systems Intervention to Reduce Opioid Use in Ambulatory Breast Surgery</title><source>MEDLINE</source><source>Springer Nature - Complete Springer Journals</source><creator>Hartford, Luke B. ; Van Koughnett, Julie Ann M. ; Murphy, Patrick B. ; Knowles, Sarah A. ; Wigen, Robin B. ; Allen, Laura J. ; Clarke, Collin F. M. ; Brackstone, Muriel ; Gray, Daryl K. ; Maciver, Allison H.</creator><creatorcontrib>Hartford, Luke B. ; Van Koughnett, Julie Ann M. ; Murphy, Patrick B. ; Knowles, Sarah A. ; Wigen, Robin B. ; Allen, Laura J. ; Clarke, Collin F. M. ; Brackstone, Muriel ; Gray, Daryl K. ; Maciver, Allison H.</creatorcontrib><description>Background
During the past 15 years, opioid-related overdose death rates for women have increased 471%. Many surgeons provide opioid prescriptions well in excess of what patients actually use. This study assessed a health systems intervention to control pain adequately while reducing opioid prescriptions in ambulatory breast surgery.
Methods
This prospective non-inferiority study included women 18–75 years of age undergoing elective ambulatory general surgical breast procedures. Pre- and postintervention groups were compared, separated by implementation of a multi-pronged, opioid-sparing strategy consisting of patient education, health care provider education and perioperative multimodal analgesic strategies. The primary outcome was average pain during the first 7 postoperative days on a numeric rating scale of 0–10. The secondary outcomes included medication use and prescription renewals.
Results
The average pain during the first 7 postoperative days was non-inferior in the postintervention group despite a significant decrease in median oral morphine equivalents (OMEs) prescribed (2.0/10 [100 OMEs] pre-intervention vs 2.1/10 [50 OMEs] post-intervention;
p
= 0.40 [
p
< 0.001]). Only 39 (44%) of the 88 patients in the post-intervention group filled their rescue opioid prescription, and 8 (9%) of the 88 patients reported needing an opioid for additional pain not controlled with acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) postoperatively. Prescription renewals did not change.
Conclusion
A standardized pain care bundle was effective in minimizing and even eliminating opioid use after elective ambulatory breast surgery while adequately controlling postoperative pain. The Standardization of Outpatient Procedure Narcotics (STOP Narcotics) initiative decreases unnecessary and unused opioid medication and may decrease risk of persistent opioid use. This initiative provides a framework for future analgesia guidelines in ambulatory breast surgery.</description><identifier>ISSN: 1068-9265</identifier><identifier>EISSN: 1534-4681</identifier><identifier>DOI: 10.1245/s10434-019-07539-w</identifier><identifier>PMID: 31342371</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Acetaminophen ; Adolescent ; Adult ; Aged ; Ambulatory Surgical Procedures - adverse effects ; Analgesia ; Analgesics ; Breast ; Breast Neoplasms - pathology ; Breast Neoplasms - surgery ; Breast Oncology ; Breast surgery ; Female ; Follow-Up Studies ; Humans ; Inflammation ; Mastectomy - adverse effects ; Medicine ; Medicine & Public Health ; Middle Aged ; Morphine ; Narcotics ; Narcotics - standards ; Narcotics - therapeutic use ; Nonsteroidal anti-inflammatory drugs ; Oncology ; Opioid-Related Disorders - prevention & control ; Opioids ; Overdose ; Pain ; Pain perception ; Pain, Postoperative - drug therapy ; Pain, Postoperative - etiology ; Patients ; Prognosis ; Prospective Studies ; Standardization ; Surgery ; Surgical Oncology ; Young Adult</subject><ispartof>Annals of surgical oncology, 2019-10, Vol.26 (10), p.3295-3304</ispartof><rights>Society of Surgical Oncology 2019</rights><rights>Annals of Surgical Oncology is a copyright of Springer, (2019). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-f853459eacc6aedb7ae7bd479c3e3b8c97d79ee2aa30c9a3a94451dde55c6bc3</citedby><cites>FETCH-LOGICAL-c375t-f853459eacc6aedb7ae7bd479c3e3b8c97d79ee2aa30c9a3a94451dde55c6bc3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1245/s10434-019-07539-w$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1245/s10434-019-07539-w$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27903,27904,41467,42536,51297</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31342371$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hartford, Luke B.</creatorcontrib><creatorcontrib>Van Koughnett, Julie Ann M.</creatorcontrib><creatorcontrib>Murphy, Patrick B.</creatorcontrib><creatorcontrib>Knowles, Sarah A.</creatorcontrib><creatorcontrib>Wigen, Robin B.</creatorcontrib><creatorcontrib>Allen, Laura J.</creatorcontrib><creatorcontrib>Clarke, Collin F. M.</creatorcontrib><creatorcontrib>Brackstone, Muriel</creatorcontrib><creatorcontrib>Gray, Daryl K.</creatorcontrib><creatorcontrib>Maciver, Allison H.</creatorcontrib><title>The Standardization of Outpatient Procedure (STOP) Narcotics: A Prospective Health Systems Intervention to Reduce Opioid Use in Ambulatory Breast Surgery</title><title>Annals of surgical oncology</title><addtitle>Ann Surg Oncol</addtitle><addtitle>Ann Surg Oncol</addtitle><description>Background
During the past 15 years, opioid-related overdose death rates for women have increased 471%. Many surgeons provide opioid prescriptions well in excess of what patients actually use. This study assessed a health systems intervention to control pain adequately while reducing opioid prescriptions in ambulatory breast surgery.
Methods
This prospective non-inferiority study included women 18–75 years of age undergoing elective ambulatory general surgical breast procedures. Pre- and postintervention groups were compared, separated by implementation of a multi-pronged, opioid-sparing strategy consisting of patient education, health care provider education and perioperative multimodal analgesic strategies. The primary outcome was average pain during the first 7 postoperative days on a numeric rating scale of 0–10. The secondary outcomes included medication use and prescription renewals.
Results
The average pain during the first 7 postoperative days was non-inferior in the postintervention group despite a significant decrease in median oral morphine equivalents (OMEs) prescribed (2.0/10 [100 OMEs] pre-intervention vs 2.1/10 [50 OMEs] post-intervention;
p
= 0.40 [
p
< 0.001]). Only 39 (44%) of the 88 patients in the post-intervention group filled their rescue opioid prescription, and 8 (9%) of the 88 patients reported needing an opioid for additional pain not controlled with acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) postoperatively. Prescription renewals did not change.
Conclusion
A standardized pain care bundle was effective in minimizing and even eliminating opioid use after elective ambulatory breast surgery while adequately controlling postoperative pain. The Standardization of Outpatient Procedure Narcotics (STOP Narcotics) initiative decreases unnecessary and unused opioid medication and may decrease risk of persistent opioid use. This initiative provides a framework for future analgesia guidelines in ambulatory breast surgery.</description><subject>Acetaminophen</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Ambulatory Surgical Procedures - adverse effects</subject><subject>Analgesia</subject><subject>Analgesics</subject><subject>Breast</subject><subject>Breast Neoplasms - pathology</subject><subject>Breast Neoplasms - surgery</subject><subject>Breast Oncology</subject><subject>Breast surgery</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Inflammation</subject><subject>Mastectomy - adverse effects</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Morphine</subject><subject>Narcotics</subject><subject>Narcotics - standards</subject><subject>Narcotics - therapeutic use</subject><subject>Nonsteroidal anti-inflammatory drugs</subject><subject>Oncology</subject><subject>Opioid-Related Disorders - prevention & control</subject><subject>Opioids</subject><subject>Overdose</subject><subject>Pain</subject><subject>Pain perception</subject><subject>Pain, Postoperative - drug therapy</subject><subject>Pain, Postoperative - etiology</subject><subject>Patients</subject><subject>Prognosis</subject><subject>Prospective Studies</subject><subject>Standardization</subject><subject>Surgery</subject><subject>Surgical Oncology</subject><subject>Young Adult</subject><issn>1068-9265</issn><issn>1534-4681</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kctu1DAUhi0EoqXwAiyQJTZlEepLHMfshgraSlWnYoa15dhnqKskDrbTangT3rYepoDEgpUv5_Nn-_wIvabkPWW1OEmU1LyuCFUVkYKr6v4JOqSibNVNS5-WOWnaSrFGHKAXKd0SQiUn4jk64JTXjEt6iH6ubwCvshmdic7_MNmHEYcNXs55KgsYM76OwYKbI-Dj1Xp5_Q5fmWhD9jZ9wItdNU1gs78DfA6mzzd4tU0ZhoQvxgzxrih2zhzwl2KxgJeTD97hrwmwH_Fi6Obe5BC3-GMEkzJezfEbxO1L9Gxj-gSvHscjtP78aX16Xl0uzy5OF5eV5VLkatOWDwsFxtrGgOukAdm5WirLgXetVdJJBcCM4cQqw42qa0GdAyFs01l-hI732imG7zOkrAefLPS9GSHMSTPWtoTSIizo23_Q2zDHsTyuUA0njApGC8X2lC2dSRE2eop-MHGrKdG73PQ-N11y079y0_fl0JtH9dwN4P4c-R1UAfgeSKU0lv78vfs_2gcjiKZ2</recordid><startdate>20191001</startdate><enddate>20191001</enddate><creator>Hartford, Luke B.</creator><creator>Van Koughnett, Julie Ann M.</creator><creator>Murphy, Patrick B.</creator><creator>Knowles, Sarah A.</creator><creator>Wigen, Robin B.</creator><creator>Allen, Laura J.</creator><creator>Clarke, Collin F. M.</creator><creator>Brackstone, Muriel</creator><creator>Gray, Daryl K.</creator><creator>Maciver, Allison H.</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20191001</creationdate><title>The Standardization of Outpatient Procedure (STOP) Narcotics: A Prospective Health Systems Intervention to Reduce Opioid Use in Ambulatory Breast Surgery</title><author>Hartford, Luke B. ; Van Koughnett, Julie Ann M. ; Murphy, Patrick B. ; Knowles, Sarah A. ; Wigen, Robin B. ; Allen, Laura J. ; Clarke, Collin F. M. ; Brackstone, Muriel ; Gray, Daryl K. ; Maciver, Allison H.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-f853459eacc6aedb7ae7bd479c3e3b8c97d79ee2aa30c9a3a94451dde55c6bc3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Acetaminophen</topic><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Ambulatory Surgical Procedures - adverse effects</topic><topic>Analgesia</topic><topic>Analgesics</topic><topic>Breast</topic><topic>Breast Neoplasms - pathology</topic><topic>Breast Neoplasms - surgery</topic><topic>Breast Oncology</topic><topic>Breast surgery</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Inflammation</topic><topic>Mastectomy - adverse effects</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Morphine</topic><topic>Narcotics</topic><topic>Narcotics - standards</topic><topic>Narcotics - therapeutic use</topic><topic>Nonsteroidal anti-inflammatory drugs</topic><topic>Oncology</topic><topic>Opioid-Related Disorders - prevention & control</topic><topic>Opioids</topic><topic>Overdose</topic><topic>Pain</topic><topic>Pain perception</topic><topic>Pain, Postoperative - drug therapy</topic><topic>Pain, Postoperative - etiology</topic><topic>Patients</topic><topic>Prognosis</topic><topic>Prospective Studies</topic><topic>Standardization</topic><topic>Surgery</topic><topic>Surgical Oncology</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hartford, Luke B.</creatorcontrib><creatorcontrib>Van Koughnett, Julie Ann M.</creatorcontrib><creatorcontrib>Murphy, Patrick B.</creatorcontrib><creatorcontrib>Knowles, Sarah A.</creatorcontrib><creatorcontrib>Wigen, Robin B.</creatorcontrib><creatorcontrib>Allen, Laura J.</creatorcontrib><creatorcontrib>Clarke, Collin F. M.</creatorcontrib><creatorcontrib>Brackstone, Muriel</creatorcontrib><creatorcontrib>Gray, Daryl K.</creatorcontrib><creatorcontrib>Maciver, Allison H.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Annals of surgical oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hartford, Luke B.</au><au>Van Koughnett, Julie Ann M.</au><au>Murphy, Patrick B.</au><au>Knowles, Sarah A.</au><au>Wigen, Robin B.</au><au>Allen, Laura J.</au><au>Clarke, Collin F. M.</au><au>Brackstone, Muriel</au><au>Gray, Daryl K.</au><au>Maciver, Allison H.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The Standardization of Outpatient Procedure (STOP) Narcotics: A Prospective Health Systems Intervention to Reduce Opioid Use in Ambulatory Breast Surgery</atitle><jtitle>Annals of surgical oncology</jtitle><stitle>Ann Surg Oncol</stitle><addtitle>Ann Surg Oncol</addtitle><date>2019-10-01</date><risdate>2019</risdate><volume>26</volume><issue>10</issue><spage>3295</spage><epage>3304</epage><pages>3295-3304</pages><issn>1068-9265</issn><eissn>1534-4681</eissn><abstract>Background
During the past 15 years, opioid-related overdose death rates for women have increased 471%. Many surgeons provide opioid prescriptions well in excess of what patients actually use. This study assessed a health systems intervention to control pain adequately while reducing opioid prescriptions in ambulatory breast surgery.
Methods
This prospective non-inferiority study included women 18–75 years of age undergoing elective ambulatory general surgical breast procedures. Pre- and postintervention groups were compared, separated by implementation of a multi-pronged, opioid-sparing strategy consisting of patient education, health care provider education and perioperative multimodal analgesic strategies. The primary outcome was average pain during the first 7 postoperative days on a numeric rating scale of 0–10. The secondary outcomes included medication use and prescription renewals.
Results
The average pain during the first 7 postoperative days was non-inferior in the postintervention group despite a significant decrease in median oral morphine equivalents (OMEs) prescribed (2.0/10 [100 OMEs] pre-intervention vs 2.1/10 [50 OMEs] post-intervention;
p
= 0.40 [
p
< 0.001]). Only 39 (44%) of the 88 patients in the post-intervention group filled their rescue opioid prescription, and 8 (9%) of the 88 patients reported needing an opioid for additional pain not controlled with acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) postoperatively. Prescription renewals did not change.
Conclusion
A standardized pain care bundle was effective in minimizing and even eliminating opioid use after elective ambulatory breast surgery while adequately controlling postoperative pain. The Standardization of Outpatient Procedure Narcotics (STOP Narcotics) initiative decreases unnecessary and unused opioid medication and may decrease risk of persistent opioid use. This initiative provides a framework for future analgesia guidelines in ambulatory breast surgery.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>31342371</pmid><doi>10.1245/s10434-019-07539-w</doi><tpages>10</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1068-9265 |
| ispartof | Annals of surgical oncology, 2019-10, Vol.26 (10), p.3295-3304 |
| issn | 1068-9265 1534-4681 |
| language | eng |
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| source | MEDLINE; Springer Nature - Complete Springer Journals |
| subjects | Acetaminophen Adolescent Adult Aged Ambulatory Surgical Procedures - adverse effects Analgesia Analgesics Breast Breast Neoplasms - pathology Breast Neoplasms - surgery Breast Oncology Breast surgery Female Follow-Up Studies Humans Inflammation Mastectomy - adverse effects Medicine Medicine & Public Health Middle Aged Morphine Narcotics Narcotics - standards Narcotics - therapeutic use Nonsteroidal anti-inflammatory drugs Oncology Opioid-Related Disorders - prevention & control Opioids Overdose Pain Pain perception Pain, Postoperative - drug therapy Pain, Postoperative - etiology Patients Prognosis Prospective Studies Standardization Surgery Surgical Oncology Young Adult |
| title | The Standardization of Outpatient Procedure (STOP) Narcotics: A Prospective Health Systems Intervention to Reduce Opioid Use in Ambulatory Breast Surgery |
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