Grand Rounds

The Opioid Crisis: Can Using A Decision Aid Decrease Opioid Prescribing Following Hysterectomy?

BACKGROUND AND PURPOSE:

Vilkins et al. (Obstet. Gynecol., 2019) analyzed the use of a shared decision-making protocol to improve opioid prescribing following hysterectomy

Prospective quality initiative study
Participants
- Hysterectomy for benign indications
Study design
- Patients received uniform education regarding post-op pain management
- Visual decision aid
  - Front: Pain expectations | Opioid risks | Common opioid side effects
  - Back (specific for type of surgery): Recommended 3-tier pain management protocol (NSAID/ Acetaminophen/ Opioids as necessary) | Scale with recommended opioid dose
- Education included
  - Departmental guidelines regarding the maximum number of tablets per prescription
  - Mean number of opioid tablets published literature
- Patients chose number of discharge prescription tablets
- Interviews 14 days post-surgery
Primary outcome
- Total opioids prescribed before compared with after implementation of the decision aid

93.5% (n=159) of eligible women used the decision aid
- Laparoscopic hysterectomy: 69.6%
- Vaginal hysterectomy: 25.3%
- Abdominal hysterectomy: 5.3%
Telephone surveys: 89.2% completed
Patients who participated in the decision aid were discharged with significantly fewer oral morphine equivalents (P<0.01)
- Decision aid cohort: 92 oral morphine equivalents
- Pre-decision aid cohort: 160 oral morphine equivalents
There was no change in the number of refills (P=0.15)
- Decision aid cohort: 9.5%
- Pre-decision aid cohort: 5.7%
In the decision aid cohort, approximately 76% of patients had leftover tablets
Retrospective data collection for pre-implementation cohort did not allow for secondary outcome analysis such as opioid consumption and patient satisfaction

The use of a decision aid following hysterectomy reduced the number of prescribed opioids
There were still leftover tablets among the patients who used the decision tool

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