A Prospective Feasibility Study Evaluating the 5x-multiplier to Standardize Discharge Prescriptions in Cancer Surgery Patients

Overview

Journal Surg Open Sci

Specialty General Surgery

Date 2022 Jun 6

PMID 35663797

Authors

Timothy P DiPeri

Timothy E Newhook

Ryan W Day

Yi-Ju Chiang

Whitney L Dewhurst

Elsa M Arvide

Morgan L Bruno

Christopher P Scally

Christina L Roland

Matthew H G Katz

Jean-Nicolas Vauthey

George J Chang

Brian D Badgwell

Nancy D Perrier

Elizabeth G Grubbs

Jeffrey E Lee

Ching-Wei D Tzeng

Affiliations

Soon will be listed here.

Abstract

Background: We designed a prospective feasibility study to assess the 5x-multiplier (5x) calculation (eg, 3 pills in last 24 hours × 5 = 15) to standardize discharge opioid prescriptions compared to usual care.

Methods: Faculty-based surgical teams volunteered for either 5x or usual care arms. Patients undergoing inpatient (≥ 48 hours) surgery and discharged by surgical teams were included. The primary end point was discharge oral morphine equivalents. Secondary end points were opioid-free discharges and 30-day refill rates.

Results: Median last 24-hour oral morphine equivalents was similar between arms (7.5 mg 5x vs 10 mg usual care, P = .830). Median discharge oral morphine equivalents were less in the 5x arm (50 mg 5x vs 75 mg usual care, P < .001). Opioid-free discharges included 33.5% 5x vs 18.0% usual care arm patients (P < .001). Thirty-day refill rates were similar (15.3% 5x vs 16.5% usual care, P = .742).

Conclusion: The 5x-multiplier was associated with reduced opioid prescriptions without increased refills and can be feasibly implemented across a diverse surgical practice.

Citing Articles

Comparative analysis of opioid use between robotic and open pancreatoduodenectomy.

Witt R, Hirata Y, Prakash L, Newhook T, Maxwell J, Kim M J Hepatobiliary Pancreat Sci. 2022; 30(4):523-531.

PMID: 35796581 PMC: 9823147. DOI: 10.1002/jhbp.1216.

References

Ogrinc G, Davies L, Goodman D, Batalden P, Davidoff F, Stevens D . SQUIRE 2.0 (Standards for QUality Improvement Reporting Excellence): revised publication guidelines from a detailed consensus process. BMJ Qual Saf. 2015; 25(12):986-992. PMC: 5256233. DOI: 10.1136/bmjqs-2015-004411. View

Newhook T, Dewhurst W, Vreeland T, Wang X, Soliz J, Speer B . Inpatient Opioid Use After Pancreatectomy: Opportunities for Reducing Initial Opioid Exposure in Cancer Surgery Patients. Ann Surg Oncol. 2019; 26(11):3428-3435. DOI: 10.1245/s10434-019-07528-z. View

Porter E, Bessen S, Molloy I, Kelly J, Ramkumar N, Phillips J . Guidelines for Patient-CenteredOpioid Prescribing and Optimal FDA-Compliant Disposal of Excess Pills after Inpatient Operation: Prospective Clinical Trial. J Am Coll Surg. 2021; 232(6):823-835.e2. DOI: 10.1016/j.jamcollsurg.2020.12.057. View

Pruitt L, Swords D, Vijayakumar S, Ostlund B, Prochazka J, Richards N . Implementation of a Quality Improvement Initiative to Decrease Opioid Prescribing in General Surgery. J Surg Res. 2019; 247:514-523. DOI: 10.1016/j.jss.2019.09.051. View

Hill M, Stucke R, Billmeier S, Kelly J, Barth Jr R . Guideline for Discharge Opioid Prescriptions after Inpatient General Surgical Procedures. J Am Coll Surg. 2017; 226(6):996-1003. DOI: 10.1016/j.jamcollsurg.2017.10.012. View

Newhook T, Vreeland T, Dewhurst W, Wang X, Prakash L, Feng C . Clinical Factors Associated With Practice Variation in Discharge Opioid Prescriptions After Pancreatectomy. Ann Surg. 2018; 272(1):163-169. DOI: 10.1097/SLA.0000000000003112. View

Newhook T, Tzeng C . ASO Author Reflections: Opportunities for Reducing Initial Opioid Exposure in Cancer Surgery Patients. Ann Surg Oncol. 2019; 26(Suppl 3):749-750. DOI: 10.1245/s10434-019-07876-w. View

Bleicher J, Stokes S, Brooke B, Glasgow R, Huang L . Patient-centered Opioid Prescribing: Breaking Away From One-Size-Fits-All Prescribing Guidelines. J Surg Res. 2021; 264:1-7. PMC: 8222090. DOI: 10.1016/j.jss.2021.01.048. View

Kim B, Lillemoe H, Newhook T, Dewhurst W, Arvide E, Katz M . Educating surgical oncology providers on perioperative opioid use: A departmental survey 1 year after the intervention. J Surg Oncol. 2020; 122(3):547-554. DOI: 10.1002/jso.25983. View

10.

Buckarma E, Thiels C, Habermann E, Glasgow A, Grotz T, Cleary S . Preoperative opioid use is associated with increased length of stay after pancreaticoduodenectomy. HPB (Oxford). 2019; 22(7):1074-1081. DOI: 10.1016/j.hpb.2019.11.010. View

11.

Newhook T, Vreeland T, Dewhurst W, Arvide E, Bruno M, Robinson K . Opioid-prescribing Practices After Oncologic Surgery: Opportunities for Improvement and a Call to Action. Ann Surg. 2019; 271(2):e9-e10. DOI: 10.1097/SLA.0000000000003595. View

12.

Vu J, Howard R, Gunaseelan V, Brummett C, Waljee J, Englesbe M . Statewide Implementation of Postoperative Opioid Prescribing Guidelines. N Engl J Med. 2019; 381(7):680-682. PMC: 7160762. DOI: 10.1056/NEJMc1905045. View

13.

Kim B, Newhook T, Blumenthaler A, Chiang Y, Aloia T, Roland C . Sustained reduction in discharge opioid volumes through provider education: Results of 1168 cancer surgery patients over 2 years. J Surg Oncol. 2021; 124(1):143-151. PMC: 8260254. DOI: 10.1002/jso.26476. View

14.

Chua K, Kimmel L, Brummett C . Disappointing Early Results From Opioid Prescribing Limits for Acute Pain. JAMA Surg. 2020; 155(5):375-376. DOI: 10.1001/jamasurg.2019.5891. View

15.

Thiels C, Anderson S, Ubl D, Hanson K, Bergquist W, Gray R . Wide Variation and Overprescription of Opioids After Elective Surgery. Ann Surg. 2017; 266(4):564-573. DOI: 10.1097/SLA.0000000000002365. View

16.

Shadbolt C, Abbott J, Camacho X, Clarke P, Lohmander L, Spelman T . The Surgeon's Role in the Opioid Crisis: A Narrative Review and Call to Action. Front Surg. 2020; 7:4. PMC: 7041404. DOI: 10.3389/fsurg.2020.00004. View

17.

Lillemoe H, Tzeng C . ASO Author Reflections: Opioid Prescribing in Surgical Oncology-Institutional Opportunities for Educational Interventions. Ann Surg Oncol. 2019; 26(Suppl 3):731-732. DOI: 10.1245/s10434-019-07837-3. View

18.

Day R, Newhook T, Dewhurst W, Arvide E, Bruno M, Vauthey J . Assessing the 5×-Multiplier Calculation to Reduce Discharge Opioid Prescription Volumes After Inpatient Surgery. JAMA Surg. 2020; 155(12):1166-1167. PMC: 7527936. DOI: 10.1001/jamasurg.2020.3527. View

19.

Chen E, Marcantonio A, Tornetta 3rd P . Correlation Between 24-Hour Predischarge Opioid Use and Amount of Opioids Prescribed at Hospital Discharge. JAMA Surg. 2017; 153(2):e174859. PMC: 5838710. DOI: 10.1001/jamasurg.2017.4859. View

20.

Kaafarani H, Han K, El Moheb M, Kongkaewpaisan N, Jia Z, El Hechi M . Opioids After Surgery in the United States Versus the Rest of the World: The International Patterns of Opioid Prescribing (iPOP) Multicenter Study. Ann Surg. 2020; 272(6):879-886. DOI: 10.1097/SLA.0000000000004225. View