The amount of opioids prescribed after gynecologic surgery declined by almost 90% with few complaints from patients after implementation of a restrictive prescription protocol, as reported here at the Society of Gynecologic Oncology (SGO) meeting.
Over a 6-month period, the total opioid pill count declined by 89% as compared with historical prescribing practices. The total included a 73% reduction the number of pills dispensed after open surgery and 97% after minimally invasive procedures.
Patients undergoing ambulatory/minimally invasive procedures and with no history of chronic pain received only prescription-strength ibuprofen or acetaminophen at discharge. Those with a history of opioid exposure or chronic pain, received a 3-day supply (12 pills) of hydrocodone-acetaminophen (Norco) or oxycodone-acetaminophen (Percocet).
Patients undergoing open surgery received either nonopioid pain medication or a 3-day opioid prescription at discharge. If a patient used an opioid for pain in the previous 24 hours, then a 3-day supply consisting of 24 pills (two every 6 hours) was prescribed.
More than 90% of patients went home without an opioid prescription after minimally invasive procedures, and fewer than 5% of patients expressed dissatisfaction with their doctors' prescribing practices under the restrictive prescribing protocol, said Jaron D. Mark, MD, of the Roswell Park Comprehensive Cancer Center in Buffalo, New York.
"We were quite surprised by how few inquiries and requests for medication we got from our patients," said Mark. "We expected that we would be able to reduce use of opioids without detrimental consequences, but the extent to which our hypothesis was supported by these results was really striking."