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#Grand Rounds

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

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BACKGROUND AND PURPOSE:

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

METHODS:

  • 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

RESULTS:

  • 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

CONCLUSION:

  • 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

Learn More – Primary Sources:

Effects of Shared Decision Making on Opioid Prescribing After Hysterectomy

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Related ObG Topics:

Can Pain Following Gyn Oncology Surgery Be Managed with a Very Restrictive Opioid Protocol?
Are the Number of Opioid Pills Prescribed Related to Consumption in Post-Op Patients?
Should Opioid Medications Be Left Out of the Treatment Plan?

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