Reducing Superfluous Opioid Prescribing Practices After Brain Surgery: It Is Time to Talk About Drugs

Authors

Karam Asmaro, Henry Ford HealthFollow
Hassan A. Fadel, Henry Ford HealthFollow
Sameah A. Haider, Henry Ford HealthFollow
Jacob Pawloski, Henry Ford HealthFollow
Edvin Telemi, Henry Ford HealthFollow
Tarek Mansour, Henry Ford HealthFollow
Ankush Chandra, Henry Ford HealthFollow
Michael Bazydlo, Henry Ford HealthFollow
Adam M. Robin, Henry Ford HealthFollow
Ian Y. Lee, Henry Ford HealthFollow
Ellen L. Air, Henry Ford HealthFollow
Jack P. Rock, Henry Ford HealthFollow
Steven N. Kalkanis, Henry Ford HealthFollow
Jason M. Schwalb, Henry Ford HealthFollow

Recommended Citation

Asmaro K, Fadel HA, Haider SA, Pawloski J, Telemi E, Mansour TR, Chandra A, Bazydlo M, Robin AM, Lee IY, Air EL, Rock JP, Kalkanis SN, and Schwalb JM. Reducing Superfluous Opioid Prescribing Practices After Brain Surgery: It Is Time to Talk About Drugs. Neurosurgery 2021.

Document Type

Article

Publication Date

4-16-2021

Publication Title

Neurosurgery

Abstract

BACKGROUND: Opioids are prescribed routinely after cranial surgery despite a paucity of evidence regarding the optimal quantity needed. Overprescribing may adversely contribute to opioid abuse, chronic use, and diversion.

OBJECTIVE: To evaluate the effectiveness of a system-wide campaign to reduce opioid prescribing excess while maintaining adequate analgesia.

METHODS: A retrospective cohort study of patients undergoing a craniotomy for tumor resection with home disposition before and after a 2-mo educational intervention was completed. The educational initiative was composed of directed didactic seminars targeting senior staff, residents, and advanced practice providers. Opioid prescribing patterns were then assessed for patients discharged before and after the intervention period.

RESULTS: A total of 203 patients were discharged home following a craniotomy for tumor resection during the study period: 98 who underwent surgery prior to the educational interventions compared to 105 patients treated post-intervention. Following a 2-mo educational period, the quantity of opioids prescribed decreased by 52% (median morphine milligram equivalent per day [interquartile range], 32.1 [16.1, 64.3] vs 15.4 [0, 32.9], P < .001). Refill requests also decreased by 56% (17% vs 8%, P = .027) despite both groups having similar baseline characteristics. There was no increase in pain scores at outpatient follow-up (1.23 vs 0.85, P = .105).

CONCLUSION: A dramatic reduction in opioids prescribed was achieved without affecting refill requests, patient satisfaction, or perceived analgesia. The use of targeted didactic education to safely improve opioid prescribing following intracranial surgery uniquely highlights the ability of simple, evidence-based interventions to impact clinical decision making, lessen potential patient harm, and address national public health concerns.

PubMed ID

33862632

ePublication

ePub ahead of print