Opioid Prescriber Education and Guidelines for Ambulatory Upper-Extremity Surgery: Evaluation of an Institutional Protocol

Jeffrey G. Stepan; Hayley A. Sacks; Francis C. Lovecchio; Ajay Premkumar; Michael C. Fu; Daniel A. Osei; Duretti T. Fufa

doi:10.1016/j.jhsa.2018.06.014

Editor's choice| Volume 44, ISSUE 2, P129-136, February 2019

Opioid Prescriber Education and Guidelines for Ambulatory Upper-Extremity Surgery: Evaluation of an Institutional Protocol

Jeffrey G. Stepan, MD, MSc
Jeffrey G. Stepan
Correspondence
Corresponding author: Jeffrey G. Stepan, MD, MSc, Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021.
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Affiliations
Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
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Hayley A. Sacks, BA
Hayley A. Sacks
Affiliations
Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
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Francis C. Lovecchio, MD
Francis C. Lovecchio
Affiliations
Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
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Ajay Premkumar, MD, MPH
Ajay Premkumar
Affiliations
Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
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Michael C. Fu, MD, MHS
Michael C. Fu
Affiliations
Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
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Daniel A. Osei, MD, MSc
Daniel A. Osei
Affiliations
Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
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Duretti T. Fufa, MD
Duretti T. Fufa
Affiliations
Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
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Published:July 19, 2018DOI:https://doi.org/10.1016/j.jhsa.2018.06.014

Purpose

Recent studies demonstrated the overprescription of opioids after ambulatory hand surgery in the setting of a national opioid epidemic. Prescriber education has been shown to decrease these practices on a small scale; however, currently no nationally standardized prescriber education or postoperative opioid prescribing guidelines exist. The purpose of this study was to evaluate the effect of prescriber opioid education and postoperative opioid guidelines on prescribing practices after ambulatory hand surgery.

Materials and Methods

This retrospective study was performed at an academic orthopedic hospital. In November, 2016, all prescribers were mandated to undergo a 1-hour opioid education program. Prescribing guidelines for the hand service were formulated based on literature review and expert opinion and were released in February, 2017. We reviewed all postoperative opioid prescriptions for patients who underwent ambulatory hand and upper-extremity surgery 4 months before the mandatory education (preeducation group) and 4 months (immediate postguideline group) and 9 to 11 months (intermediate postguideline group) after the guideline dissemination.

Results

A total of 1,348 ambulatory hand surgeries (435 in the preeducation, 490 in the immediate postguideline group, and 423 in the intermediate postguidelines groups) with postoperative opioid prescriptions met inclusion criteria. Mean reduction in total prescribed oral morphine equivalents was 52.3% after guidelines disseminated. The number of opioid pills prescribed to patients decreased significantly in the postguideline groups when stratified by procedure type and surgery level.

Conclusions

Prescriber education and postoperative opioid guideline dissemination led to significant decreases in the number of opioid pills prescribed after ambulatory hand surgery. Development and dissemination of nationally standardized prescriber education and opioid guidelines may significantly reduce the amount of opioid medications prescribed after hand surgery.

Type of study/level of evidence

Therapeutic IV.

Key words

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Article info

Publication history

Published online: July 19, 2018

Accepted: June 12, 2018

Received: October 31, 2017

Footnotes

No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.

Identification

DOI: https://doi.org/10.1016/j.jhsa.2018.06.014

Copyright

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