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REDUCING OVERUSE OF OPIOID

PRESCRIPTIONS IN OUTPATIENT

GENERAL SURGERYSURGERY VALUE SYMPOSIUM

BENJAMIN BROOKE, MD, AUSTIN CANNON, MD, ADAM DZUIBA, MD,

LILY GUTNIK, MD, LUKE MARTIN, MD, SEAN STOKES, MD, MARK TAYLOR, MD

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DISCLOSURES

• None

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Defining the Problem

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http://www.cnn.com/2016/09/23/health/heroin-opioid-drug-overdose-deaths-visual-guide/index.html

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”Until clinicians stop prescribing opioids far in

excess of clinical need, this crisis will continue

unabated.”

Califf RM,Woodcock J, Ostroff S. A proactive response to prescription opioid

abuse. New Engl J Med. 2016;374:1480–1485.

Robert Califf, MD

Former Commissioner of the FDA

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AcutePain

OverRx

How much do prescription practices vary at the University of Utah for common general surgery procedures?

Hypothesis: Outpatient general surgery prescription practices vary widely and standardization will reduce cost and narcotic over-prescription without effects on patient satisfaction

OUR QUESTION

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Analysis/Investigation

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WHERE CAN WE MAKE A DIFFERENCE?

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PRESCRIBED

TAKEN

• Partial mastectomy• Partial mastectomy + SLNB• Laparoscopic

cholecystectomy• Laparoscopic Inguinal Hernia

Repair• Open Inguinal Hernia Repair

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• 17,167 tablets prescribed

• 7,360 estimated tablets prescribed (42.8%)

Estimated Need for post-operative General Surgery patientsPartial mastectomy – 5 pillsPartial mastectomy w/ SLNB – 10 pillsLap chole – 15 pills Lap IHR – 15 pillsOpen IHR – 15 pills

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“PORCA” – PAIN ORCA

• Operating Room Cost Accountability (ORCA)

• Pain “ORCA” = PORCA

• Utility that allows tracking of prescribing

practices by practitioner and CPT code

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LAPAROSCOPIC CHOLECYSTECTOMY(7/4/2016-6/29/2017)

Surgeon (de-identified)

Ave

rage

Tab

lets

Rx

Perc

ent

Tota

l Po

pu

lati

on

Tablets Prescribed15 tablets

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ESTIMATED IMPACT – LAP CHOLE

• 421 lap chole cases

• 11, 773 tablets prescribed (avg. 28 tabs/case)

• Using proposed standardized Rx practice

– Reduce to 6,315 tablets prescribed (53.6%)

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Proposed

Intervention

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ORDER SET

• Standardize

prescriptions for the

procedures of

interest

– Lap chole

– IHR – open and lap

– VHR

– Lumpectomy +/-

SLNB

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Impact

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GOING FORWARD

• Patient perception of acute pain management

• Analysis of Rx practice within PORCA

• Post-intervention patient perception

Aug Sept Oct Nov Dec Jan Feb Mar

Pre-intervention Survey

Intervention Data Collection/Analysis

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Perc

ent

Tota

l Po

pu

lati

on

Tablets Prescribed

Overall Goal

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Questions?

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REFERENCES

1. Hill, Maureen V., et al. "Wide variation and excessive dosage of opioid prescriptions for common general

surgical procedures." Annals of surgery 265.4 (2017): 709-714.

2. Wunsch, Hannah, et al. "Opioids prescribed after low-risk surgical procedures in the United States, 2004-

2012." Jama 315.15 (2016): 1654-1657.

3. https://dopl.utah.gov/programs/csdb/

4. Olsen, Yngvild. "The CDC guideline on opioid prescribing: rising to the challenge." Jama 315.15 (2016):

1577-1579.

5. Lillernoe, Keith D. "Annals of Surgery Looks at The Opioid Crisis." Annals of surgery 265.4 (2017).

6. Brummett, Chad M., et al. "New Persistent Opioid Use After Minor and Major Surgical Procedures in US

Adults." JAMA surgery (2017): e170504-e170504.

7. Utah Department of Health Opioid Prescribing Guidelines

8. Hill, Maureen V., et al. "An Educational Intervention Decreases Opioid Prescribing After General Surgical

Operations." Annals of Surgery (2017).

9. http://www.cnn.com/2016/09/23/health/heroin-opioid-drug-overdose-deaths-visual-guide/index.html