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The Impact of Education and Prescribing Guidelines on Opioid Prescribing for Breast and Melanoma Procedures

  • Health Services Research and Global Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Excessive opioid prescribing is common in surgical oncology, with 72% of prescribed opioids going unused after curative-intent surgery. In this study, we sought to reduce opioid prescribing after breast and melanoma procedures by designing and implementing an intervention focused on education and prescribing guidelines, and then evaluating the impact of this intervention.

Methods

In this single-institution study, we designed and implemented an intervention targeting key factors identified in qualitative interviews. This included mandatory education for prescribers, evidence-based prescribing guidelines, and standardized patient instructions. After the intervention, interrupted time-series analysis was used to compare the mean quantity of opioid prescribed before and after the intervention (July 2016–September 2017). We also evaluated the frequency of opioid prescription refills.

Results

During the study, 847 patients underwent breast or melanoma procedures and received an opioid prescription. For mastectomy or wide local excision for melanoma, the mean quantity of opioid prescribed immediately decreased by 37% after the intervention (p = 0.03), equivalent to 13 tablets of oxycodone 5 mg. For lumpectomy or breast biopsy, the mean quantity of opioid prescribed decreased by 42%, or 12 tablets of oxycodone 5 mg (p = 0.07). Furthermore, opioid prescription refills did not significantly change for mastectomy/wide local excision (13% vs. 14%, p = 0.8), or lumpectomy/breast biopsy (4% vs. 5%, p = 0.7).

Conclusion

Education and prescribing guidelines reduced opioid prescribing for breast and melanoma procedures without increasing the need for refills. This suggests further reductions in opioid prescribing may be possible, and provides rationale for implementing similar interventions for other procedures and practice settings.

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Funding

Dr. Lee is a National Research Service Award postdoctoral fellow supported by the National Cancer Institute (5T32 CA009672-23). Drs. Englesbe, Waljee, and Brummett receive funding from the Michigan Department of Health and Human Services and the National Institute on Drug Abuse (RO1 DA042859). The content of this study is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the Michigan Department of Health and Human Services.

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Authors and Affiliations

  1. Department of Surgery, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA

    Jay S. Lee MD, Ryan A. Howard MD, Michael P. Klueh BS, Michael J. Englesbe MD, Jennifer F. Waljee MD, MPH, MS, Michael S. Sabel MD & Lesly A. Dossett MD, MPH

  2. Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA

    Jay S. Lee MD, Michael J. Englesbe MD, Jennifer F. Waljee MD, MPH, MS & Lesly A. Dossett MD, MPH

  3. Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA

    Chad M. Brummett MD

  4. Division of Surgical Oncology, Michigan Medicine, Ann Arbor, MI, USA

    Lesly A. Dossett MD, MPH

Authors
  1. Jay S. Lee MD
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  2. Ryan A. Howard MD
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  3. Michael P. Klueh BS
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  4. Michael J. Englesbe MD
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  5. Jennifer F. Waljee MD, MPH, MS
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  6. Chad M. Brummett MD
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  7. Michael S. Sabel MD
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  8. Lesly A. Dossett MD, MPH
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Corresponding author

Correspondence to Lesly A. Dossett MD, MPH.

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Supplemental Fig. 1

Surgical Oncology Service Protocol for Postoperative Pain Medications. All prescribers in surgical oncology received a written protocol describing the new opioid prescribing guidelines and key points for patient education. The protocol also described strategies to optimize pain control while minimizing the need for opioids, such as infiltration of long-acting local anesthetic prior to incision. (TIFF 26451 kb)

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Lee, J.S., Howard, R.A., Klueh, M.P. et al. The Impact of Education and Prescribing Guidelines on Opioid Prescribing for Breast and Melanoma Procedures. Ann Surg Oncol 26, 17–24 (2019). https://doi.org/10.1245/s10434-018-6772-3

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  • DOI: https://doi.org/10.1245/s10434-018-6772-3

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