Journal of the American College of Surgeons · 2025
Impact of Nonhepatectomy Opioid Reduction Efforts on Posthepatectomy Opioid Prescription: Analysis of 2,005 Patients.
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Fields Brittany C, Newhook Timothy E, Prakash Laura R, Arvide Elsa M, Li Zhouxuan, Tran Cao Hop S, Maxwell Jessica E, Perrier Nancy D, Katz Matthew Hg, Vauthey Jean-Nicolas, Tzeng Ching-Wei D
Аннотация
BACKGROUND: Pathway-driven, postpancreatectomy opioid reduction interventions have proven effective and sustainable and may have a "halo effect" on other major abdominal cancer operations. This study aimed to analyze the sequential effects of expanding opioid reduction efforts from pancreatectomy on opioids prescribed after hepatectomy.
STUDY DESIGN: This was a retrospective cohort study using data from the electronic health record and a prospective quality improvement database for consecutive hepatectomy patients (September 2016 to February 2024). Cohorts were based on 5 distinct eras of opioid-related protocol updates E1 (preintervention historical baseline): September 2016 to March 2017; E2 (introduction of 5x-multiplier): April 2017 to September 2018; E3 (departmental opioid education program): October 2018 to December 2019; E4 (initial posthepatectomy pathways): January 2020 to June 2022; and E5 (updated pancreatectomy pathways influencing hepatectomy care): July 2022 to February 2024).
RESULTS: Of 2,005 patients, 31% underwent major hepatectomy, 14% intermediate, 46% minor, and 9% combination surgery/other. Most (79%) patients were performed via an open approach. The median hospital stay decreased from 5 to 4 days between E1 and E5. Both intraoperative (E1, 80 mg; E5, 37 mg; p < 0.001) and total inpatient (E1 181 mg, E5 86 mg; p < 0.001) median oral morphine equivalents were reduced by >50%. A 73% reduction in discharge oral morphine equivalents was observed between E1 (225 mg) and E5 (60 mg; p < 0.001), with clinically similar median pain scores at discharge (scores 1 to 2 of 10). Concurrent universal adoption of routine 3-drug nonopioid discharge prescriptions (E1 70%, E5 98%) correlated with the proportion of patients discharged opioid-free (E1 8%, E5 43%; p < 0.001).
CONCLUSIONS: Directed opioid reduction efforts for pancreatectomy influenced clinically meaningful posthepatectomy reductions in inpatient and discharge opioid volumes. A "halo effect" of intradepartmental opioid reduction efforts is attainable and corresponds to measurable increases in opioid-free or nearly opioid-free discharges after major abdominal cancer surgery.
STUDY DESIGN: This was a retrospective cohort study using data from the electronic health record and a prospective quality improvement database for consecutive hepatectomy patients (September 2016 to February 2024). Cohorts were based on 5 distinct eras of opioid-related protocol updates E1 (preintervention historical baseline): September 2016 to March 2017; E2 (introduction of 5x-multiplier): April 2017 to September 2018; E3 (departmental opioid education program): October 2018 to December 2019; E4 (initial posthepatectomy pathways): January 2020 to June 2022; and E5 (updated pancreatectomy pathways influencing hepatectomy care): July 2022 to February 2024).
RESULTS: Of 2,005 patients, 31% underwent major hepatectomy, 14% intermediate, 46% minor, and 9% combination surgery/other. Most (79%) patients were performed via an open approach. The median hospital stay decreased from 5 to 4 days between E1 and E5. Both intraoperative (E1, 80 mg; E5, 37 mg; p < 0.001) and total inpatient (E1 181 mg, E5 86 mg; p < 0.001) median oral morphine equivalents were reduced by >50%. A 73% reduction in discharge oral morphine equivalents was observed between E1 (225 mg) and E5 (60 mg; p < 0.001), with clinically similar median pain scores at discharge (scores 1 to 2 of 10). Concurrent universal adoption of routine 3-drug nonopioid discharge prescriptions (E1 70%, E5 98%) correlated with the proportion of patients discharged opioid-free (E1 8%, E5 43%; p < 0.001).
CONCLUSIONS: Directed opioid reduction efforts for pancreatectomy influenced clinically meaningful posthepatectomy reductions in inpatient and discharge opioid volumes. A "halo effect" of intradepartmental opioid reduction efforts is attainable and corresponds to measurable increases in opioid-free or nearly opioid-free discharges after major abdominal cancer surgery.