The following is a summary of “Discharge Prescribing Protocol Decreases Opioids in Circulation and Does Not Increase Refills After Colorectal Surgery,” published in the June 2023 issue of Diseases of the Colon and Rectum by Bauer et al.
Approximately 10% of patients experience the onset of prolonged opioid utilization following a surgical procedure. Researcher’s objective was to evaluate the prescribing protocols and patient utilization of opioids following colorectal surgery. This study aimed to establish an opioid-prescribing protocol to reduce the number of postoperative opioids defined, thereby mitigating their circulation within the community and minimizing the likelihood of persistent use among patients. This was a single-institution, prospective study based on questionnaires of postoperative patients in 2019 and 2020 to ascertain opioid prescribing and utilization patterns. Based on these preliminary findings, a medical protocol was implemented wherein patients were discharged with either 5 or 15 oxycodone 5 mg equivalents, depending on their opioid usage, within 24 hours before discharge. The participants underwent a survey following the implementation of the medical protocol.
The medical facility serves as a prominent referral center for the surgical management of colorectal disease—adult individuals who have undergone inpatient abdominal colorectal procedures. The endpoints encompassed the number of opioids prescribed, the number of prescribed opioids consumed, and the rate of refills. Nonparametric testing was employed in the analysis. Out of 77 patients who met the criteria, 61 had no prior exposure to opioids. Before the implementation of the established medical protocol, patients who had not previously been exposed to opioids (n = 29) were prescribed a median of 30 tablets (interquartile range [IQR], 30–45). However, they only consumed a median of 10 tablets (IQR, 0–10; P < 0.0001)—eighty-three percent of patients consumed 20 or fewer pills. Following the implementation of the protocol, 32 patients who had not previously been exposed to opioids were prescribed a reduced number of tablets (median 15; interquartile range, 7–15; P< 0.0001). However, these patients consumed comparable pills to the preprotocol group (median 10; interquartile range, 0–10; P = 0.21).
The rate of medication refills showed no significant difference (13.8% vs. 18.8%; P = 0.60). The adherence to the protocol was 90.6%. This study is constrained by the small number of participants, the diversity within the group, and the ability to apply the findings to a broader population. Patients consumed a notably lower quantity of opioids compared to the prescribed dosage. Researchers medical protocol effectively regulated the prescription of opioids, reducing excessive prescribing and decreasing the availability of opioids within the community. This positive outcome was achieved without incurring any additional burdens, such as an increase in the number of prescription refills. Long-term clinical investigations are required to evaluate the consequences of prolonged opioid utilization following surgical procedures.