Persistent Improvement in Opioid Perceptions and Prescribing for Cancer Surgery: 5-Year Follow-Up.

Abstract

Background and objectives: We previously reported that implementation of a department-wide opioid education program led to post-education improvements in opioid perceptions and prescription recommendations, with one-month and one-year retention. With ongoing programmatic and quality improvement efforts, we sought to re-evaluate the retention of these improvements five years after initial efforts.

Methods: Attending surgeons, clinical fellows, and advanced practice providers were surveyed five years after implementation of a comprehensive, departmental opioid reduction framework in August 2018. This framework initially consisted of dedicated opioid education sessions and retrospective assessment of prescribing practices, and subsequently expanded over time to include prospective quality improvement and implementation studies, as well as integration of opioid stewardship measures into usual clinical care. Providers' perceptions of expected pain scores, opioid requirements, and ideal prescribing habits were assessed with the same survey administered at 1-month (2018) and 1-year post-initial education (2019).

Results: Eighty-seven of 162 (53.7%) providers responded to the follow-up survey. More providers expressed strong agreement with the statement, "After an inpatient procedure, a patient who has not required opioids for 24 hours before discharge should not receive a discharge opioid prescription." Significant decreases in the number of opioid pills providers would prescribe at discharge for five sample operations were also observed between 2018-2023. Stepwise decreases in opioid volume prescribed in both inpatient and outpatient settings were reported since the initial 2018 education sessions.

Conclusions: Dedicated department-wide opioid education, ongoing quality improvement and prospective evaluation, and integration of opioid stewardship into clinical practice were associated with sustained improvement over five years in perceptions of postoperative pain management and decreased discharge opioid prescription recommendations.