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Quality Improvement/Clinical Outcomes

E379: Persistent Improvement in Opioid Perceptions and Prescribing for Cancer Surgery: 5-Year Follow-Up

Introduction: We previously reported that implementation of a department-wide opioid education program demonstrated post-education changes in opioid perceptions and prescription recommendations with retention at 1-month and 1-year follow-up. With ongoing programmatic and quality improvement (QI) efforts since August 2018, we sought to evaluate retention of these trends 5 years later.

Methods: Within the Department of Surgical Oncology, we surveyed faculty, clinical fellows, and advanced practice providers (APPs) 5 years after our first opioid education program in August 2018. Ongoing education included annual trainee opioid education during orientation and department-wide QI projects targeting procedures for melanoma, gastric cancer, sarcoma, hepatobiliary and pancreatic tumors, and peritoneal surface malignancies. Providers’ perceptions of expected pain scores, opioid requirements, and ideal prescribing habits were assessed with the same survey. 

Results: Excluding non-respondents in 2018 and 2019, the 2023 response rate was 53.3% (87/163), of which 35.6% had completed a prior survey. The response rate by clinical role was 59.0% (36/61) faculty, 73.1% (19/26) fellows, and 42.7% (32/75) APPs. Unlike 2018, no differences were observed between clinical roles regarding overall perceptions of perioperative pain management. Over time, more providers of each type strongly agreed patients not requiring opioids in the last 24 hours before discharge should not receive a discharge opioid prescription (97.5% vs. 51.0% agreement at initial survey, p=0.035). Providers reported continued decreases in opioid volume prescribed in both inpatient and outpatient settings since our initial education sessions. When asked the number of discharge opioid pills they would prescribe for each of 5 sample operations, a significant decrease was observed between 2018 and 2023 (open abdominal resection, 30 vs. 10 pills; laparoscopic colectomy, 20 vs. 5; wide local excision with sentinel node, 12 vs. 5; thyroidectomy, 14 vs. 5; port placement, 8 vs. 0; p< 0.009; Figure 1). Corresponding increases over time in non-opioid analgesia prescriptions, such as muscle relaxants (59.8% vs. 37.5%, p=0.038), in the outpatient setting were also observed. 

Conclusions:

Dedicated department-wide opioid education with annual fellow orientation and ongoing QI projects for faculty and APPs are associated with sustained improvement over 5 years in provider perceptions of perioperative pain management and decreased volumes of recommended discharge opioid prescriptions.

Learning Objectives:

  • To identify clear benefits of ongoing opioid education and quality improvement projects in reduced opioid prescribing.
  • To describe acceptable volumes of post-operative opioid pills for select operations.
  • To visualize effect of ongoing opioid education and quality improvement projects on perceptions of appropriate post-operative pain scores and post-operative day off opioid medications.