Effect of a Prospective Opioid Reduction Intervention on Opioid Prescribing and Use after Radical Prostatectomy: Results of the ORIOLES Initiative.

To evaluate the effect of a prospective opioid reduction intervention after radical prostatectomy (based on a surgery-specific guideline and education) on post-discharge opioid prescribing, use, disposal, and need for additional opioid mediation.

A prospective, non-randomized, pre-post interventional trial of patients undergoing radical prostatectomy for prostate cancer (August 2017-November 2018) was conducted as part of ORIOLES. An evidence-based intervention including a discharge sheet, nursing education, and standardized prescribing guideline was applied with primary outcome of total oral morphine equivalents (OMEQ) used after surgery. Secondary outcomes included opioid prescribing, opioid disposal, need for additional opioid medication, and presence of incisional/post-surgical abdominal pain past 30-days.

A total of 214 (pre-intervention arm) and 229 (post-intervention arm) adult patients were enrolled (100% follow-up). The intervention reduced post-discharge opioid prescribing (224.3mg to 120.3mg; -46.4%, p=0.01), reduced opioid use (52.1mg to 38.3mg; -26.5%, p<0.01), and increased opioid disposal (+13.5%, p<0.01). Greater prescribing of opioids at discharge, higher BMI, and use of opioid medication prior to surgery were independently associated with greater post-discharge opioid use while history of a chronic pain diagnosis was not statistically significant. In the post-intervention cohort, 2.2% of patients needed additional medication for post-surgical pain (0.9% obtained a prescription), and 1.3% initiated long-term use.

A prospective, evidence-based intervention reduced post-discharge opioid prescribing and use while increasing disposal after radical prostatectomy. Risk factors for increased opioid use were identified. The results support expanding the use of evidence-based opioid reduction interventions to other surgical specialties.

BJU international. 2019 Oct 23 [Epub ahead of print]

Hiten D Patel, Farzana A Faisal, Neil D Patel, Christian P Pavlovich, Mohamad E Allaf, Misop Han, Amin S Herati

The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD., Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.