Impact of Nonhepatectomy Opioid Reduction Efforts on Posthepatectomy Opioid Prescription: Analysis of 2,005 Patients.

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.