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Impact of a tiered discharge opioid algorithm on prescriptions and patient-reported outcomes after open gynecologic surgery.
Huepenbecker, Sarah; Hillman, Robert Tyler; Iniesta, Maria D; Chen, Tsun; Cain, Katherine; Mena, Gabriel; Lasala, Javier; Wang, Xin Shelley; Williams, Loretta; Taylor, Jolyn S; Lu, Karen H; Ramirez, Pedro T; Meyer, Larissa A.
  • Huepenbecker S; Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
  • Hillman RT; Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
  • Iniesta MD; Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
  • Chen T; Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
  • Cain K; Division of Pharmacy, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
  • Mena G; Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
  • Lasala J; Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
  • Wang XS; Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
  • Williams L; Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
  • Taylor JS; Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
  • Lu KH; Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
  • Ramirez PT; Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
  • Meyer LA; Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA lmeyer@mdanderson.org.
Int J Gynecol Cancer ; 31(7): 1052-1060, 2021 07.
Article in English | MEDLINE | ID: covidwho-1504094
ABSTRACT

OBJECTIVE:

To compare discharge opioid refills, prescribed morphine equivalent dose and quantity, and longitudinal patient-reported outcomes before and after implementation of a tiered opioid prescribing algorithm among women undergoing open gynecologic surgery within an enhanced recovery after surgery program.

METHODS:

We compared opioid prescriptions, clinical outcomes, and patient-reported outcomes among 273 women. Post-discharge symptom burden was collected up to 42 days after discharge using the validated 27-item MD Anderson Symptom Inventory and analyzed using linear mixed effects models and Kaplan-Meier curves for symptom recovery.

RESULTS:

Among 113 pre-implementation and 160 post-implementation patients there was no difference in opioid refills (9.7% vs 11.3%, p=0.84). The post-implementation cohort had a significant reduction in median morphine equivalent dose (112.5 mg vs 225 mg, p<0.01), with no difference in median hospital length of stay (3 days vs 3 days, p=1.0) or 30-day readmission rate (9.4% vs 7.1%, p=0.66). There was no difference in patient-reported pain between the pre- and post-implementation cohorts on the day of discharge (severity 4.93 vs 5.14, p=0.53) or in any patient-reported symptoms, interference measures, or composite scores by post-discharge day 7. The median recovery time for most symptoms was 7 days, except for pain (14 days), fatigue (18 days), and physical interference (21 days), with no differences between cohorts.

CONCLUSIONS:

After implementation of a tiered opioid prescribing algorithm, the quantity and dose of discharge opioids prescribed decreased with no change in post-operative refills and without negatively impacting patient-reported symptom burden or interference, which can be used to educate and reassure patients and providers.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pain, Postoperative / Patient Discharge / Gynecologic Surgical Procedures / Analgesics, Opioid Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study Topics: Long Covid Limits: Adult / Aged / Female / Humans / Middle aged Language: English Journal: Int J Gynecol Cancer Journal subject: Gynecology / Neoplasms Year: 2021 Document Type: Article Affiliation country: Ijgc-2021-002674

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pain, Postoperative / Patient Discharge / Gynecologic Surgical Procedures / Analgesics, Opioid Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study Topics: Long Covid Limits: Adult / Aged / Female / Humans / Middle aged Language: English Journal: Int J Gynecol Cancer Journal subject: Gynecology / Neoplasms Year: 2021 Document Type: Article Affiliation country: Ijgc-2021-002674