Surgeon's gloved hand reaching for an instrument

Collaborative Efforts Reduce Post-Surgery Opioid Prescription Numbers

Pain is a normal outcome of surgery. Recent efforts to counsel patients on that reality, along with alternative pain management methods and adherence to evidence-based guidelines for prescribing opioids, appear to be working when it comes to reducing the number of opioid pills patients are sent home with.

A recent research letter in the New England Journal of Medicine detailed results of the effort, which helped surgical teams follow evidence-based opioid prescribing guidelines developed at the University of Michigan as part of broader efforts spearheaded by a team from the Michigan Opioid Prescribing Engagement Network or Michigan-OPEN.

Working collaboratively, Michigan hospitals and surgeons across the state cut the number of opioid prescriptions for nine common operations by nearly a third in a year’s time, from an average of 26 pills per patient to an average of 18. The operations studied were laparoscopic cholecystectomy, appendectomy, minor hernia repair (open or laparoscopic), open ventral/incisional hernia repair, laparoscopic or open colectomy, and vaginal, abdominal or minimally invasive hysterectomy.

Additionally, patient ratings for post-surgery pain and satisfaction didn’t change from the ratings given by patients treated in the six months before the opioid-reducing effort. Even though prescription amounts were smaller, patients also reported only taking about half the opioids they were prescribed. Researchers think improved counseling before surgery attributed to the drop.

The study includes prescription data from 11,716 patients who had operations at hospitals participating in the Michigan Surgical Quality Collaborative. Just over half of patients also filled out surveys after their operations, reporting on pain, satisfaction and opioid use levels.

“The success of the statewide effort suggests an opportunity for other states to build on Michigan’s experience, and room for even further reductions in prescription size,” said Michael Englesbe, M.D., the U-M surgery professor who heads MSQC and co-directs Michigan-OPEN, in a news release. “At the same time, we need to make sure that patients also know how to safely dispose of any leftover opioids they don’t take.”

In the time since the study ended, the Michigan-OPEN team has revised its surgical prescribing guideline to suggest even smaller prescriptions for these operations and has added over 15 other operations and procedures. Meanwhile, a Michigan law aimed at reducing excess opioid prescribing for acute pain took effect just after the study period, though the law allows for a much larger prescription than the Michigan-OPEN guidelines recommend.

MSQC is funded by Blue Cross Blue Shield of Michigan to improve surgical quality and safety across the state, one of many collaborative quality initiatives we support. Michigan-OPEN is funded by the Michigan Department of Health and Human Services and BCBSM and is based at the U-M Institute for Healthcare Policy and Innovation.

“Across the CQIs, we’re really impacting the opioid epidemic,” explained David Bye, manager, Clinical Program Development, Value Partnerships, BCBSM. “MSQC, in their work with Michigan-OPEN, has led the way. Many other CQIs have joined the fight though by implementing new prescribing standards which are evidence-based and combined with patient reported outcomes. This is fueling the cycle of continuous improvement as they continue to expand recommendations to new procedures and target the ideal prescription size for patients to achieve the best outcomes.”

Learn more about collaborative quality initiatives.

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Photo credit: Morsa Images

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