Implementation of Post-operative Standard Opioid Prescribing Schedules Reduces Opioid Prescriptions Without Change in Patient-Reported Pain Outcomes.

OBJECTIVE To implement Standard Opioid Prescribing Schedules (SOPS) based on opioid use following urologic surgeries and to evaluate how evidence-based prescribing schedules affect opioid use and patient reported outcomes. METHODS Patients who underwent urologic surgeries within six procedure subtypes at UNC Health during the two study time periods ("pre-SOPS": 7/2017-1/2018, "post-SOPS": 7/2018-1/2019) were invited to complete a survey analyzing postoperative opioid usage, storage and disposal, and patient reported outcomes (including pain interference using a validated questionnaire). A pharmacy database provided medication prescribing data and patient demographics. During the pre-SOPS time period, baseline outcomes were measured. Following the pre-SOPS period, usage amounts were analyzed and Standard Opioid Prescribing Schedules were developed to guide prescriptions during the post-SOPS period. Descriptive summary statistics and appropriate t-test or r-squared were calculated. RESULTS 438 patients within six procedure types completed the survey (pre-SOPS: 282 patients, post-SOPS: 156 patients). Pre-SOPS, patients were prescribed significantly more 5 mg oxycodone tablets than used (20.9 vs 7.8, p<0.001). Post-SOPS, compared to pre-SOPS amounts, patients were prescribed significantly fewer tablets (12.7 vs. 20.9, p<0.001) and used fewer tablets (5.3 vs. 7.8, p=0.003). No difference was observed in pain interference (average t-score (standard deviation): 54.33 (10.9) pre-SOPS vs 55.89 (9.1) post-SOPS, p=0.125) or patient satisfaction (95% pre-SOPS vs 94% post-SOPS). CONCLUSIONS Adherence to data-driven post-operative opioid prescribing schedules reduce opioid prescriptions and use without compromising pain interference or patient satisfaction. These results have important implications for urologists' ability to decrease opioid prescriptions and fight the opioid epidemic.