Assessment Of Postoperative Opioid Stewardship Using A Novel Electronic Based Automated Text And Phone Messaging Platform
*Bradley S. Kushner, *Margaret Sehnert, *Wen Hui Tan, *Katie Jordan, *Rebecca Aft, *Matthew Silviera, L. Michael Brunt
Washington University in St. Louis, SAINT LOUIS, MO
Objectives: Opioid abuse is a major public health crisis and surgeons must do their part to practice responsible opioid stewardship. Prescribing practices vary widely across general surgery providers and are often based on routine rather than data-driven practices. The goal of this study was to use an electronic text-based platform to assess post-discharge opioid utilization in postoperative general surgery patients.
Methods: A prospective, cohort study enrolled adult patients undergoing surgery across three sections: Minimally Invasive Surgery, Colorectal, and Surgical Oncology. Both open and laparoscopic cases were included. Using an electronic platform (ePharmix), SMS text messages were sent to enrolled patients on post-discharge days (PDD) 1-7, 14, 21 and 28 inquiring about the number of opioid pills taken since discharge and pain medication refills. For statistical analysis, procedural interventions were grouped based on procedural similarity and expected postoperative pain level. RedCap (RedCap 7.3.5, Vanderbilt University) and GraphPad Prism were used for data collection and statistical analysis (ANOVA).
Results: A total of 185 patients enrolled and completed the intervention. Patient participation was robust: 82% of patients responded to >50% of all text-based questions and 64% responded to >80% of questions. Dropout rate was minimal (<1-2% for each PDD time-interval). Total prescribed MME varied significantly between procedural groups (p<0.0001) [Table 1]. Patients undergoing bariatric surgery were prescribed the most narcotic pain medications (average MME: 262.50; median MME: 225), and those undergoing endocrine surgery the least (average MME: 48.83; median MME: 55). Bariatric patients consumed the greatest total average MME (97.70) and breast surgery patients consumed the greatest percentage post-discharge (41.3%). Median opioid pills consumed was ≤3 for all procedure categories except bariatric surgery. Only four patients requested an opioid refill by PDD 28.
Conclusion: Although prescribing practices vary widely between surgical procedures, a text-based platform can reliably track patient's opioid usage post-discharge across different procedures. Such a platform may facilitate the development of data driven, standardized opioid prescribing practices matched to patients' procedures and anticipated opioid usage post-discharge.
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