Changing the default: A prospective study of reducing discharge opioid prescription after lumpectomy and sentinel node biopsy Journal Article
| Authors: | Moo, T. A.; Pawloski, K. R.; Sevilimedu, V.; Charyn, J.; Simon, B. A.; Sclafani, L. M.; Plitas, G.; Barrio, A. V.; Kirstein, L. J.; Van Zee, K. J.; Morrow, M. |
| Article Title: | Changing the default: A prospective study of reducing discharge opioid prescription after lumpectomy and sentinel node biopsy |
| Abstract: | Background: Whether routinely prescribed opioids are necessary for pain control after discharge among lumpectomy/sentinel node biopsy (Lump/SLNB) patients is unclear. We hypothesize that Lump/SLNB patients could be discharged without opioids, with a failure rate < 10%. This study prospectively examines outcomes after changing standard discharge prescription from an opioid/non-steroidal anti-inflammatory drug (NSAID) to NSAID/acetaminophen. Patients and Methods: Standard discharge pain medication orders included opioids in the first 3-month study period and were changed to NSAID/acetaminophen in the second 3-month period. Patient-reported medication consumption and pain scores were collected by post-discharge survey. Frequency of discharge with opioid, NSAID/acetaminophen failure rate, opioid use, and pain scores were examined. Results: From May to October 2019, 663 patients had Lump/SLNB: 371 in the opioid study period and 292 in the NSAID period. In the opioid period, 92% (342/371) of patients were prescribed an opioid at discharge; of 142 patients who documented opioid use on the survey, 86 (61%) used zero tablets. Among 56 (39%) patients who used opioids, the median number taken by POD 5 was 4. After the change to NSAID/acetaminophen, rates of opioid prescription decreased to 14% (41/292). The NSAID/acetaminophen failure rate was 2% (5/251). Among survey respondents, there was no significant difference in the maximum reported pain scores (POD 1–5) between the opioid period and the NSAID period (p = 0.7). Conclusions: In Lump/SLNB patients, a change to default discharge with NSAID/acetaminophen resulted in a 78% absolute reduction in opioid prescription, with a failure rate of 2% and no difference in patient-reported pain scores. Most Lump/SLNB patients can be discharged with NSAID/acetaminophen. © 2020, Society of Surgical Oncology. |
| Journal Title: | Annals of Surgical Oncology |
| Volume: | 27 |
| Issue: | 12 |
| ISSN: | 1068-9265 |
| Publisher: | Springer |
| Date Published: | 2020-11-01 |
| Start Page: | 4637 |
| End Page: | 4642 |
| Language: | English |
| DOI: | 10.1245/s10434-020-08886-9 |
| PUBMED: | 32734370 |
| PROVIDER: | scopus |
| PMCID: | PMC7554186 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 2 November 2020 -- Source: Scopus |
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