Implementation and Assessment of No Opioid Prescription Strategy at Discharge After Major Urologic Cancer Surgery
Authors' conclusion
This perioperative protocol, with emphasis on nonopioid alternatives and patient instructions, may be safe and effective in nearly eliminating the need for opioid prescriptions after major abdominopelvic cancer surgery without adversely affecting pain control, complications, or recovery.
Study context
- Population
- Opioid-naive patients undergoing open or minimally invasive radical cystectomy, radical or partial nephrectomy, or radical prostatectomy at a tertiary referral center, May 2017–June 2021opioid-naive
- Participants
- 647 patients
- Exposure
- No opioid prescriptions at discharge vs reduced opioids vs usual opioids
- Controln = 194reference
- Lead-inn = 95
- NOPIOIDSn = 358
- Outcome
- Rate and dose of opioid prescriptions at discharge and for 30 days postdischarge
- Follow-up
- Discharge and 30 days postdischarge
Methodological detailssingle-centre, tertiary referral center
- Single-centre
- Tertiary referral center
Main finding
As reported in the abstract
Rate of opioid prescriptions at discharge; tablets prescribed per patient · discharge
| Group | Value | Median tablets prescribed (IQR) |
|---|---|---|
| Control | 80.9% | 14 (10-20) |
| Lead-in | 57.9% | 4 (0-5.3) |
| NOPIOIDS | 2.2% | 0 (0-0) |
Value
Control80.9%
Lead-in57.9%
NOPIOIDS2.2%
Median tablets prescribed (IQR)
Control14 (10-20)
Lead-in4 (0-5.3)
NOPIOIDS0 (0-0)
- Control, Lead-in, NOPIOIDS: P < 0.001
- Control, Lead-in, NOPIOIDS: P < 0.001
Observational data: associations, not effects.
Further findings
- Opioid dose by procedure type (NOPIOIDS)
- 0.5 · mean · SD 1.7 · tablets
- Patient-reported pain score (NOPIOIDS)
- 2.5 · mean · SD 0.86
- Satisfaction score (NOPIOIDS)
- 86.6 · mean · SD 3.8
- Patient-reported pain score (NOPIOIDS): surveys from 358 patients (72.6%)
Opioid dose by procedure type (NOPIOIDS)
- Median and mean dose 0 tablets for all procedure types except kidney procedures (value shown)
Safety
- No increase in postoperative complications in the NOPIOIDS group
Original publication
Implementation and Assessment of No Opioid Prescription Strategy at Discharge After Major Urologic Cancer Surgery. JAMA Surg. Published 1 April 2023. doi:10.
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