Opioid-Free Discharge After Pancreatic Resection Through a Learning Health System Paradigm
Authors' conclusion
In this cohort study, the median total inpatient OME was halved and median discharge OME reduced to zero in association with a learning health system model of iterative opioid reduction that is freely adaptable by other hospitals.
Study context
- Population
- Consecutive adults undergoing pancreatic resection at an urban comprehensive cancer center, October 2016 to April 2022
- Participants
- 832 consecutive patients
- Exposure
- 3 iterative risk-stratified pancreatectomy clinical pathway versions
- V1n = 363reference
- V2n = 229
- V3n = 240
- Outcome
- Inpatient and discharge opioid volume in oral morphine equivalents (OME)
Methodological detailsconsecutive patients, single-centre, learning health system, sequential pathway cohorts
- Consecutive patients
- Single-centre
- Learning health system
- Sequential pathway cohorts
Main finding
As reported in the abstract
| Group | Value | Discharge OME, median |
|---|---|---|
| V1 | median 290 (IQR 157-468 mg) mg | 150 mg (IQR, 100-225 mg) |
| V2 | median 184 (IQR 103-311 mg) mg | 25 mg (IQR, 0-100 mg) |
| V3 | median 129 (IQR 75-206 mg) mg | 0 mg (IQR, 0-50 mg) |
Value
V1median 290 (IQR 157-468 mg) mg
V2median 184 (IQR 103-311 mg) mg
V3median 129 (IQR 75-206 mg) mg
Discharge OME, median
V1150 mg (IQR, 100-225 mg)
V225 mg (IQR, 0-100 mg)
V30 mg (IQR, 0-50 mg)
- V1, V2, V3: P < 0.001
- V1, V2, V3: P < 0.001
Observational data: associations, not effects.
Further findings
| Outcome | V1 | V3 | P value |
|---|---|---|---|
| Discharged opioid freeV3 vs V1 | 7.2% | 52.5% | P < 0.001 |
| Discharged with ≤50 mg OME | — not stated in the abstract | 187 of 240 (77.9%) | |
| Early nonopioid bundle administrationV3 vs V1 | P < 0.001 | ||
| Acetaminophen | 320 patients [88.2%] | 236 patients [98.3%] | |
| Celecoxib or anti-inflammatory | 98 patients [27.0%] | 163 patients [67.9%] | |
| Methocarbamol | 267 patients [73.6%] | 238 patients [99.2%] |
— not stated in the abstract
Pain scores
- Median pain scores remained 3 or lower in all cohorts
Open vs minimally invasive surgery (subgroup)
- Similar results in both groups
Safety
- No differences in postdischarge refill requests
Original publication
Opioid-Free Discharge After Pancreatic Resection Through a Learning Health System Paradigm. JAMA Surg. Published 8 November 2023. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →