Optimization of Opioid Discharge Prescriptions Following Thyroid and Parathyroid Surgery

Elsie Rizk; Fangzheng Yuan; Feibi Zheng; Ezekiel Fink; Navjot Kaur; Anh Thu Tran; Tomona Iso; Nadia G. Mohyuddin; Apurva A. Thekdi; Gilchrist L. Jackson; Matthew A. Wanat; J. Douglas Thornton; Joshua T.  Swan

doi:10.1177/01945998221121626

Optimization of Opioid Discharge Prescriptions Following Thyroid and Parathyroid Surgery

Elsie Rizk, Fangzheng Yuan, Feibi Zheng, Ezekiel Fink, Navjot Kaur, Anh Thu Tran, Tomona Iso, Nadia G. Mohyuddin, Apurva A. Thekdi, Gilchrist L. Jackson, Matthew A. Wanat, J. Douglas Thornton, Joshua T. Swan

Research output: Contribution to journal › Article › peer-review

Abstract

OBJECTIVE: To evaluate the impact of a quality improvement bundle on opioid discharge prescribing following thyroidectomy and parathyroidectomy.

METHODS: This before-and-after study included patients undergoing thyroidectomy or parathyroidectomy at an academic medical center. The quality improvement bundle included a patient education flyer, electronic health record order sets with multimodal analgesia regimens, and provider education. The preimplementation cohort included patients treated from January 2018 to December 2019. The postimplementation cohort included patients treated from June 2021 to August 2021. The primary outcome was the proportion of patients who received new opioid discharge prescriptions.

RESULTS: A total of 160 patients were included in the preimplementation cohort, and the first 80 patients treated after bundle implementation were included in the postimplementation cohort. Patients receiving new opioid discharge prescriptions decreased from 80% (128/160) in the preimplementation cohort to 35% (28/80) in the postimplementation cohort with an unadjusted absolute reduction of 45% (95% CI, 33%-57%; P < .001; number needed to treat = 3) and an adjusted odds ratio (OR) of 0.08 (95% CI, 0.04-0.19; P < .001). The bundle was associated with reductions in opioid discharge prescriptions that exceeded 112.5 oral morphine milligram equivalents (33% pre- vs 10% postimplementation; adjusted OR, 0.20; P = .001) or 5 days of therapy (17% pre- vs 6% postimplementation; adjusted OR, 0.34; P = .049).

DISCUSSION: Implementation of a pain management quality improvement bundle reduced opioid discharge prescribing following thyroidectomy and parathyroidectomy.

IMPLICATIONS FOR PRACTICE: Unnecessary opioid prescriptions generate unused opioids in patients' homes that can lead to opioid misuse. We believe that this bundle reduced the risk for opioid misuse in our community.

REGISTRATION: The study was registered at ClinicalTrials.gov (NCT04955444) before implementation.

Original language	English (US)
Pages (from-to)	176-184
Number of pages	9
Journal	Otolaryngology - Head and Neck Surgery (United States)
Volume	169
Issue number	1
DOIs	https://doi.org/10.1177/01945998221121626
State	Published - Jul 2023

Keywords

opioid stewardship
opioids
pain management
parathyroidectomy
patient safety/quality improvement
thyroidectomy
Humans
Patient Discharge
Thyroid Gland
Drug Prescriptions
Analgesics, Opioid/therapeutic use
Opioid-Related Disorders
Retrospective Studies
Pain, Postoperative/drug therapy

ASJC Scopus subject areas

Surgery
Otorhinolaryngology

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10.1177/01945998221121626

Cite this

Rizk, E., Yuan, F., Zheng, F., Fink, E., Kaur, N., Tran, A. T., Iso, T., Mohyuddin, N. G., Thekdi, A. A., Jackson, G. L., Wanat, M. A., Thornton, J. D., & Swan, J. T. (2023). Optimization of Opioid Discharge Prescriptions Following Thyroid and Parathyroid Surgery. Otolaryngology - Head and Neck Surgery (United States), 169(1), 176-184. https://doi.org/10.1177/01945998221121626

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title = "Optimization of Opioid Discharge Prescriptions Following Thyroid and Parathyroid Surgery",

abstract = "OBJECTIVE: To evaluate the impact of a quality improvement bundle on opioid discharge prescribing following thyroidectomy and parathyroidectomy.METHODS: This before-and-after study included patients undergoing thyroidectomy or parathyroidectomy at an academic medical center. The quality improvement bundle included a patient education flyer, electronic health record order sets with multimodal analgesia regimens, and provider education. The preimplementation cohort included patients treated from January 2018 to December 2019. The postimplementation cohort included patients treated from June 2021 to August 2021. The primary outcome was the proportion of patients who received new opioid discharge prescriptions.RESULTS: A total of 160 patients were included in the preimplementation cohort, and the first 80 patients treated after bundle implementation were included in the postimplementation cohort. Patients receiving new opioid discharge prescriptions decreased from 80% (128/160) in the preimplementation cohort to 35% (28/80) in the postimplementation cohort with an unadjusted absolute reduction of 45% (95% CI, 33%-57%; P < .001; number needed to treat = 3) and an adjusted odds ratio (OR) of 0.08 (95% CI, 0.04-0.19; P < .001). The bundle was associated with reductions in opioid discharge prescriptions that exceeded 112.5 oral morphine milligram equivalents (33% pre- vs 10% postimplementation; adjusted OR, 0.20; P = .001) or 5 days of therapy (17% pre- vs 6% postimplementation; adjusted OR, 0.34; P = .049).DISCUSSION: Implementation of a pain management quality improvement bundle reduced opioid discharge prescribing following thyroidectomy and parathyroidectomy.IMPLICATIONS FOR PRACTICE: Unnecessary opioid prescriptions generate unused opioids in patients' homes that can lead to opioid misuse. We believe that this bundle reduced the risk for opioid misuse in our community.REGISTRATION: The study was registered at ClinicalTrials.gov (NCT04955444) before implementation.",

keywords = "opioid stewardship, opioids, pain management, parathyroidectomy, patient safety/quality improvement, thyroidectomy, Humans, Patient Discharge, Thyroid Gland, Drug Prescriptions, Analgesics, Opioid/therapeutic use, Opioid-Related Disorders, Retrospective Studies, Pain, Postoperative/drug therapy",

author = "Elsie Rizk and Fangzheng Yuan and Feibi Zheng and Ezekiel Fink and Navjot Kaur and Tran, {Anh Thu} and Tomona Iso and Mohyuddin, {Nadia G.} and Thekdi, {Apurva A.} and Jackson, {Gilchrist L.} and Wanat, {Matthew A.} and Thornton, {J. Douglas} and Swan, {Joshua T.}",

note = "Funding Information: Funding source: This work was supported by Texas Targeted Opioid Response, a public health initiative operated by the Texas Health and Human Services Commission through federal funding from the Substance Abuse and Mental Health Services Administration (SAMHSA) grant award number 1H79TI083288. The views and opinions contained in this research do not formally represent those of SAMHSA, the U.S. Department of Health and Human Services, or the Texas Health and Human Services Commission, and should not be construed as such. Publisher Copyright: {\textcopyright} 2022 American Academy of Otolaryngology–Head and Neck Surgery Foundation.",

year = "2023",

month = jul,

doi = "10.1177/01945998221121626",

language = "English (US)",

volume = "169",

pages = "176--184",

journal = "Otolaryngology - Head and Neck Surgery (United States)",

issn = "0194-5998",

publisher = "Mosby Inc.",

number = "1",

}

TY - JOUR

T1 - Optimization of Opioid Discharge Prescriptions Following Thyroid and Parathyroid Surgery

AU - Rizk, Elsie

AU - Yuan, Fangzheng

AU - Zheng, Feibi

AU - Fink, Ezekiel

AU - Kaur, Navjot

AU - Tran, Anh Thu

AU - Iso, Tomona

AU - Mohyuddin, Nadia G.

AU - Thekdi, Apurva A.

AU - Jackson, Gilchrist L.

AU - Wanat, Matthew A.

AU - Thornton, J. Douglas

AU - Swan, Joshua T.

N1 - Funding Information: Funding source: This work was supported by Texas Targeted Opioid Response, a public health initiative operated by the Texas Health and Human Services Commission through federal funding from the Substance Abuse and Mental Health Services Administration (SAMHSA) grant award number 1H79TI083288. The views and opinions contained in this research do not formally represent those of SAMHSA, the U.S. Department of Health and Human Services, or the Texas Health and Human Services Commission, and should not be construed as such. Publisher Copyright: © 2022 American Academy of Otolaryngology–Head and Neck Surgery Foundation.

PY - 2023/7

Y1 - 2023/7

N2 - OBJECTIVE: To evaluate the impact of a quality improvement bundle on opioid discharge prescribing following thyroidectomy and parathyroidectomy.METHODS: This before-and-after study included patients undergoing thyroidectomy or parathyroidectomy at an academic medical center. The quality improvement bundle included a patient education flyer, electronic health record order sets with multimodal analgesia regimens, and provider education. The preimplementation cohort included patients treated from January 2018 to December 2019. The postimplementation cohort included patients treated from June 2021 to August 2021. The primary outcome was the proportion of patients who received new opioid discharge prescriptions.RESULTS: A total of 160 patients were included in the preimplementation cohort, and the first 80 patients treated after bundle implementation were included in the postimplementation cohort. Patients receiving new opioid discharge prescriptions decreased from 80% (128/160) in the preimplementation cohort to 35% (28/80) in the postimplementation cohort with an unadjusted absolute reduction of 45% (95% CI, 33%-57%; P < .001; number needed to treat = 3) and an adjusted odds ratio (OR) of 0.08 (95% CI, 0.04-0.19; P < .001). The bundle was associated with reductions in opioid discharge prescriptions that exceeded 112.5 oral morphine milligram equivalents (33% pre- vs 10% postimplementation; adjusted OR, 0.20; P = .001) or 5 days of therapy (17% pre- vs 6% postimplementation; adjusted OR, 0.34; P = .049).DISCUSSION: Implementation of a pain management quality improvement bundle reduced opioid discharge prescribing following thyroidectomy and parathyroidectomy.IMPLICATIONS FOR PRACTICE: Unnecessary opioid prescriptions generate unused opioids in patients' homes that can lead to opioid misuse. We believe that this bundle reduced the risk for opioid misuse in our community.REGISTRATION: The study was registered at ClinicalTrials.gov (NCT04955444) before implementation.

AB - OBJECTIVE: To evaluate the impact of a quality improvement bundle on opioid discharge prescribing following thyroidectomy and parathyroidectomy.METHODS: This before-and-after study included patients undergoing thyroidectomy or parathyroidectomy at an academic medical center. The quality improvement bundle included a patient education flyer, electronic health record order sets with multimodal analgesia regimens, and provider education. The preimplementation cohort included patients treated from January 2018 to December 2019. The postimplementation cohort included patients treated from June 2021 to August 2021. The primary outcome was the proportion of patients who received new opioid discharge prescriptions.RESULTS: A total of 160 patients were included in the preimplementation cohort, and the first 80 patients treated after bundle implementation were included in the postimplementation cohort. Patients receiving new opioid discharge prescriptions decreased from 80% (128/160) in the preimplementation cohort to 35% (28/80) in the postimplementation cohort with an unadjusted absolute reduction of 45% (95% CI, 33%-57%; P < .001; number needed to treat = 3) and an adjusted odds ratio (OR) of 0.08 (95% CI, 0.04-0.19; P < .001). The bundle was associated with reductions in opioid discharge prescriptions that exceeded 112.5 oral morphine milligram equivalents (33% pre- vs 10% postimplementation; adjusted OR, 0.20; P = .001) or 5 days of therapy (17% pre- vs 6% postimplementation; adjusted OR, 0.34; P = .049).DISCUSSION: Implementation of a pain management quality improvement bundle reduced opioid discharge prescribing following thyroidectomy and parathyroidectomy.IMPLICATIONS FOR PRACTICE: Unnecessary opioid prescriptions generate unused opioids in patients' homes that can lead to opioid misuse. We believe that this bundle reduced the risk for opioid misuse in our community.REGISTRATION: The study was registered at ClinicalTrials.gov (NCT04955444) before implementation.

KW - opioid stewardship

KW - opioids

KW - pain management

KW - parathyroidectomy

KW - patient safety/quality improvement

KW - thyroidectomy

KW - Humans

KW - Patient Discharge

KW - Thyroid Gland

KW - Drug Prescriptions

KW - Analgesics, Opioid/therapeutic use

KW - Opioid-Related Disorders

KW - Retrospective Studies

KW - Pain, Postoperative/drug therapy

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U2 - 10.1177/01945998221121626

DO - 10.1177/01945998221121626

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AN - SCOPUS:85138274133

SN - 0194-5998

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JO - Otolaryngology - Head and Neck Surgery (United States)

JF - Otolaryngology - Head and Neck Surgery (United States)

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ER -

Optimization of Opioid Discharge Prescriptions Following Thyroid and Parathyroid Surgery

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