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A Program to Reduce Post-Operative Opioid Prescribing at a Veteran’s Affairs Hospital

Variability in surgeon prescribing patterns is common in the post-operative period and can be the nidus for dependence and addiction. This project aims to reduce opioid overprescribing at the Veteran’s Affairs Pittsburgh Healthcare System (VAPHS). The VAPHS Opioid Stewardship Committee collaborated...

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Autores principales: Hlavin, Callie, Muluk, Sruthi, Muluk, Visala, Ryan, John, Wagner, Jeffrey, Dhupar, Rajeev
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9506192/
https://www.ncbi.nlm.nih.gov/pubmed/36143098
http://dx.doi.org/10.3390/jcm11185453
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author Hlavin, Callie
Muluk, Sruthi
Muluk, Visala
Ryan, John
Wagner, Jeffrey
Dhupar, Rajeev
author_facet Hlavin, Callie
Muluk, Sruthi
Muluk, Visala
Ryan, John
Wagner, Jeffrey
Dhupar, Rajeev
author_sort Hlavin, Callie
collection PubMed
description Variability in surgeon prescribing patterns is common in the post-operative period and can be the nidus for dependence and addiction. This project aims to reduce opioid overprescribing at the Veteran’s Affairs Pittsburgh Healthcare System (VAPHS). The VAPHS Opioid Stewardship Committee collaborated to create prescribing guidelines for inpatient and outpatient general, thoracic, and vascular surgery procedures. We incorporated bundled order sets into the provider workflow in the electronic medical system and performed a retrospective cohort study comparing opioid prescription patterns for Veterans who underwent any surgical procedure for a three-month period pre- and post- guideline implementation. After implementation of opioid prescribing guidelines, morphine milligram equivalents (MME), quantity of pills prescribed, and days prescribed were statistically significantly reduced for procedures with associated guidelines, including cholecystectomy (MME 140.8 vs. 57.5, p = 0.002; quantity 18.8 vs. 8, p = 0.002; days 5.1 vs. 2.8, p = 0.021), inguinal hernia repair (MME 129.9 vs. 45.3, p = 0.002; quantity 17.3 vs. 6.1, p = 0.002; days 5.0 vs. 2.4, p = 0.002), and umbilical hernia repair (MME 128.8 vs. 53.8, p = 0.002; quantity 17.1 vs. 7.8, p = 0.002; days 5.1 vs. 2.5, p = 0.022). Procedures without associated recommendations also preceded a decrease in overall opioid prescribing. Post-operative opioid prescribing guidelines can steer clinicians toward more conscientious opioid disbursement. There may also be reductions in prescribing opioids for procedures without guidelines as an indirect effect of practice change.
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spelling pubmed-95061922022-09-24 A Program to Reduce Post-Operative Opioid Prescribing at a Veteran’s Affairs Hospital Hlavin, Callie Muluk, Sruthi Muluk, Visala Ryan, John Wagner, Jeffrey Dhupar, Rajeev J Clin Med Article Variability in surgeon prescribing patterns is common in the post-operative period and can be the nidus for dependence and addiction. This project aims to reduce opioid overprescribing at the Veteran’s Affairs Pittsburgh Healthcare System (VAPHS). The VAPHS Opioid Stewardship Committee collaborated to create prescribing guidelines for inpatient and outpatient general, thoracic, and vascular surgery procedures. We incorporated bundled order sets into the provider workflow in the electronic medical system and performed a retrospective cohort study comparing opioid prescription patterns for Veterans who underwent any surgical procedure for a three-month period pre- and post- guideline implementation. After implementation of opioid prescribing guidelines, morphine milligram equivalents (MME), quantity of pills prescribed, and days prescribed were statistically significantly reduced for procedures with associated guidelines, including cholecystectomy (MME 140.8 vs. 57.5, p = 0.002; quantity 18.8 vs. 8, p = 0.002; days 5.1 vs. 2.8, p = 0.021), inguinal hernia repair (MME 129.9 vs. 45.3, p = 0.002; quantity 17.3 vs. 6.1, p = 0.002; days 5.0 vs. 2.4, p = 0.002), and umbilical hernia repair (MME 128.8 vs. 53.8, p = 0.002; quantity 17.1 vs. 7.8, p = 0.002; days 5.1 vs. 2.5, p = 0.022). Procedures without associated recommendations also preceded a decrease in overall opioid prescribing. Post-operative opioid prescribing guidelines can steer clinicians toward more conscientious opioid disbursement. There may also be reductions in prescribing opioids for procedures without guidelines as an indirect effect of practice change. MDPI 2022-09-16 /pmc/articles/PMC9506192/ /pubmed/36143098 http://dx.doi.org/10.3390/jcm11185453 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Hlavin, Callie
Muluk, Sruthi
Muluk, Visala
Ryan, John
Wagner, Jeffrey
Dhupar, Rajeev
A Program to Reduce Post-Operative Opioid Prescribing at a Veteran’s Affairs Hospital
title A Program to Reduce Post-Operative Opioid Prescribing at a Veteran’s Affairs Hospital
title_full A Program to Reduce Post-Operative Opioid Prescribing at a Veteran’s Affairs Hospital
title_fullStr A Program to Reduce Post-Operative Opioid Prescribing at a Veteran’s Affairs Hospital
title_full_unstemmed A Program to Reduce Post-Operative Opioid Prescribing at a Veteran’s Affairs Hospital
title_short A Program to Reduce Post-Operative Opioid Prescribing at a Veteran’s Affairs Hospital
title_sort program to reduce post-operative opioid prescribing at a veteran’s affairs hospital
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9506192/
https://www.ncbi.nlm.nih.gov/pubmed/36143098
http://dx.doi.org/10.3390/jcm11185453
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