Surgical Opioid Stewardship for Orthopedic Surgery: A Quality Improvement Initiative.

Authors

Dylan J Parker
Heather Geist, Lehigh Valley Health NetworkFollow
Ali Yazdanyar DO, Lehigh Valley Health NetworkFollow
Joshua Rosentel BSn, RN, Lehigh Valley Health NetworkFollow
Matthew McCambridge MD, Lehigh Valley Health NetworkFollow
Victoria Chestnut DNP, MBA, RN, CCCTM, Lehigh Valley Health NetworkFollow
Alisa Matthews MSN, RN, CCCTM, Lehigh Valley Health NetworkFollow
Melinda Liptak PA-C, Lehigh Valley Health NetworkFollow
Eric B. Lebby MD, Lehigh Valley Health NetworkFollow
Gillian A. Beauchamp MD, Lehigh Valley Health NetworkFollow

Publication/Presentation Date

2-10-2023

Abstract

The aim of this quality improvement initiative was to reduce unnecessary opioid prescribing by sharing data with prescribers on opioid use by patients. In our study, transition of care clinicians performed follow-up phone calls to select postoperative orthopedic patients to determine opioid use. We implemented a standardized postoperative 7-day opioid wean and designed a dashboard to track the information gathered. We calculated descriptive statistics for continuous and categorical variables. In the initial assessment of opioid use by orthopedic patients, the study consisted of 296 patients with a mean age of 64.8±11.4 years, 147 females (49.7%) and 149 males (50.3%), 59.1% joint replacements (hip, knee, shoulder), and 40.9% spine surgeries (lumbar decompression, cervical fusion, hemilaminectomy). Among those prescribed an opioid, 50% received a prescription for 30 pills or less and 52.4% reported taking more than 80% of the opioid pills, while 35.1% reported taking less than 60%. In the prescribing quality improvement assessment, there were a total of 1547 hospitalizations for joint replacement surgeries from June 2018 to June 2020: 774 (50.0%) hips and 773 (50.0%) knees. There was a significant difference in morphine milligram equivalents per day and quantity prescribed when comparing the preintervention period with the postintervention period without significant increases in opioid refill requests or return visit rates. In our study, sharing data around patient opioid use and provider-facing prescribing metrics reduced postoperative opioid prescribing without significantly increasing opioid refill or emergency department return visit rates. [

First Page

1

Last Page

7

ISSN

1938-2367

Published In/Presented At

Parker, D. J., Geist, H., Yazdanyar, A., Rosentel, J., McCambridge, M., Chestnut, V., Matthews, A., Liptak, M. E., Lebby, E. B., & Beauchamp, G. A. (2023). Surgical Opioid Stewardship for Orthopedic Surgery: A Quality Improvement Initiative. Orthopedics, 1–7. Advance online publication. https://doi.org/10.3928/01477447-20230207-05

Disciplines

Medicine and Health Sciences

PubMedID

36779731

Department(s)

Department of Emergency Medicine, Patient Care Services / Nursing, Administration and Leadership, Department of Surgery, Toxicology Division

Document Type

Article