By improving hospital care pathways, researchers from The University of Texas MD Anderson Cancer Center successfully reduced inpatient opioid use by 50% after pancreatic cancer surgery and cut the median opioid prescription volumes at discharge to zero. This approach, described in a study published in JAMA Surgery, could help reduce the risk of long-term opioid dependence in patients.
In this cohort study, which involved 832 patients undergoing pancreatic resection surgery, the researchers investigated how making incremental modifications to post-surgery procedures affected the amounts of opioids used by inpatients and at the point of discharge. In less than four years, the total inpatient oral morphine equivalents (OME) decreased from a median of 290 mg to 129 mg, while OME at discharge decreased from a median of 150 mg to 0 mg. Over 75% of patients were discharged with ≤ 50 mg OME, which is fewer than 10 pills.
The study included three consecutive cohorts, each with iterative revisions to post-surgical clinical pathways, from 2018 to 2022. After establishing a baseline and reducing length of stay, the team updated patient-provider education handouts, limited intravenous opioids, suggested a three-drug non-opioid bundle, and implemented a “5x-multiplier” (equal to OME over the last 24 hours multiplied by 5) to calculate an appropriate amount of opioids to prescribe at discharge.
Median pain scores remained ≤3 out of 10 in all cohorts, with no differences in post-discharge refill requests. Most patients did not require opioid refills after discharge, and there were no differences between cohorts. A subgroup analysis separating open and minimally invasive cases showed similar results in both groups.
Trial participants underwent 541 pancreatoduodenectomies, 285 distal pancreatectomies and six other pancreatectomies. The median age was 65 years, and 611 patients were white, 90 were Hispanic, 58 were Asian, 56 were Black and 17 were other.
The University of Texas MD Anderson Cancer Center release on Newswise
