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Large reduction in opioid prescribing by a multipronged behavioral intervention after major urologic surgery
Author(s) -
Jacobs Bruce L.,
Rogers Devin,
Yabes Jonathan G.,
Bandari Jathin,
Ayyash Omar M.,
Maganty Avinash,
Armann Kody M.,
Worku Hermoon A.,
Pace Natalie M.,
Shah Anup,
Pekala Kelly R.,
Yu Michelle,
Chelly Jacques E.,
Macleod Liam C.,
Davies Benjamin J.
Publication year - 2021
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.33200
Subject(s) - medicine , prostatectomy , opioid , nephrectomy , intervention (counseling) , anxiety , anesthesia , kidney , prostate , nursing , psychiatry , cancer , receptor
Background Surgeons play a pivotal role in combating the opioid crisis that currently grips the United States. Changing surgeon behavior is difficult, and the degree to which behavioral science can steer surgeons toward decreased opioid prescribing is unclear. Methods This was a single‐institution, single‐arm, pre‐ and postintervention study examining the prescribing of opioids by urologists for adult patients undergoing prostatectomy or nephrectomy. The primary outcome was the quantity of opioids prescribed in oral morphine equivalents (OMEs) after hospital discharge. The primary exposure was a multipronged behavioral intervention designed to decrease opioid prescribing. The intervention had 3 components: 1) formal education, 2) individual audit feedback, and 3) peer comparison performance feedback. There were 3 phases to the study: a pre‐intervention phase, an intervention phase, and a washout phase. Results Three hundred eighty‐two patients underwent prostatectomy, and 306 patients underwent nephrectomy. The median OMEs decreased from 195 to 19 in the prostatectomy patients and from 200 to 0 in the nephrectomy patients ( P < .05 for both). The median OMEs prescribed did not increase during the washout phase. Prostatectomy patients discharged with opioids had higher levels of anxiety than patients discharged without opioids ( P < .05). Otherwise, prostatectomy and nephrectomy patients discharged with and without opioids did not differ in their perception of postoperative pain management, activity levels, psychiatric symptoms, or somatic symptoms ( P > .05 for all). Conclusions Implementing a multipronged behavioral intervention significantly reduced opioid prescribing for patients undergoing prostatectomy or nephrectomy without compromising patient‐reported outcomes.