Evidence-based opioid prescribing guidelines after lung resection: a prospective, multicenter analysis

Jarred R. Mondoñedo; Alexander A. Brescia; Melissa J. Clark; Matthew L. Chang; Shannon Jiang; Chang He; Robert J. Welsh; Andrew M. Popoff; Mohan G. Kulkarni; Shelly C. Lall; Jerry W. Pratt; Kumari N. Adams; Raed M. Alnajjar; James R. Martin; Divyakant B. Gandhi; Chad M. Brummett; Andrew C. Chang; Kiran H. Lagisetty

doi:10.21037/jtd-22-1621

Evidence-based opioid prescribing guidelines after lung resection: a prospective, multicenter analysis

Jarred R. Mondoñedo, Alexander A. Brescia, Melissa J. Clark, Matthew L. Chang, Shannon Jiang, Chang He, Robert J. Welsh, Andrew M. Popoff, Mohan G. Kulkarni, Shelly C. Lall, Jerry W. Pratt, Kumari N. Adams, Raed M. Alnajjar, James R. Martin, Divyakant B. Gandhi, Chad M. Brummett, Andrew C. Chang, Kiran H. Lagisetty

Section of Cardiac Surgery

Research output: Contribution to journal › Article › peer-review

1 Scopus citations

Abstract

Background: Opioid prescribing guidelines have significantly decreased overprescribing and post-discharge use after cardiac surgery; however, limited recommendations exist for general thoracic surgery patients, a similarly high-risk population. We examined opioid prescribing and patient-reported use to develop evidence-based, opioid prescribing guidelines after lung cancer resection. Methods: This prospective, statewide, quality improvement study was conducted between January 2020 to March 2021 and included patients undergoing surgical resection of a primary lung cancer across 11 institutions. Patient-reported outcomes at 1-month follow-up were linked with clinical data and Society of Thoracic Surgery (STS) database records to characterize prescribing patterns and post-discharge use. The primary outcome was quantity of opioid used after discharge; secondary outcomes included quantity of opioid prescribed at discharge and patient-reported pain scores. Opioid quantities are reported in number of 5-mg oxycodone tablets (mean ± standard deviation). Results: Of the 602 patients identified, 429 met inclusion criteria. Questionnaire response rate was 65.0%. At discharge, 83.4% of patients were provided a prescription for opioids of mean size 20.5±13.1 pills, while patients reported using 8.2±13.0 pills after discharge (P<0.001), including 43.7% who used none. Those not taking opioids on the calendar day prior to discharge (32.4%) used fewer pills (4.4±8.1 vs. 11.7±14.9, P<0.001). Refill rate was 21.5% for patients provided a prescription at discharge, while 12.5% of patients not prescribed opioids at discharge required a new prescription before follow-up. Pain scores were 2.4±2.5 for incision site and 3.0±2.8 for overall pain (scale 0–10). Conclusions: Patient-reported post-discharge opioid use, surgical approach, and in-hospital opioid use before discharge should be used to inform prescribing recommendations after lung resection.

Original language	English
Pages (from-to)	3285-3294
Number of pages	10
Journal	Journal of Thoracic Disease
Volume	15
Issue number	6
DOIs	https://doi.org/10.21037/jtd-22-1621
State	Published - Jun 2023

Keywords

lung cancer
Opioid prescribing
practice guidelines
thoracic surgery

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10.21037/jtd-22-1621

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Mondoñedo, J. R., Brescia, A. A., Clark, M. J., Chang, M. L., Jiang, S., He, C., Welsh, R. J., Popoff, A. M., Kulkarni, M. G., Lall, S. C., Pratt, J. W., Adams, K. N., Alnajjar, R. M., Martin, J. R., Gandhi, D. B., Brummett, C. M., Chang, A. C., & Lagisetty, K. H. (2023). Evidence-based opioid prescribing guidelines after lung resection: a prospective, multicenter analysis. Journal of Thoracic Disease, 15(6), 3285-3294. https://doi.org/10.21037/jtd-22-1621

@article{198df324d6504a54843c658941e7b94f,

title = "Evidence-based opioid prescribing guidelines after lung resection: a prospective, multicenter analysis",

abstract = "Background: Opioid prescribing guidelines have significantly decreased overprescribing and post-discharge use after cardiac surgery; however, limited recommendations exist for general thoracic surgery patients, a similarly high-risk population. We examined opioid prescribing and patient-reported use to develop evidence-based, opioid prescribing guidelines after lung cancer resection. Methods: This prospective, statewide, quality improvement study was conducted between January 2020 to March 2021 and included patients undergoing surgical resection of a primary lung cancer across 11 institutions. Patient-reported outcomes at 1-month follow-up were linked with clinical data and Society of Thoracic Surgery (STS) database records to characterize prescribing patterns and post-discharge use. The primary outcome was quantity of opioid used after discharge; secondary outcomes included quantity of opioid prescribed at discharge and patient-reported pain scores. Opioid quantities are reported in number of 5-mg oxycodone tablets (mean ± standard deviation). Results: Of the 602 patients identified, 429 met inclusion criteria. Questionnaire response rate was 65.0%. At discharge, 83.4% of patients were provided a prescription for opioids of mean size 20.5±13.1 pills, while patients reported using 8.2±13.0 pills after discharge (P<0.001), including 43.7% who used none. Those not taking opioids on the calendar day prior to discharge (32.4%) used fewer pills (4.4±8.1 vs. 11.7±14.9, P<0.001). Refill rate was 21.5% for patients provided a prescription at discharge, while 12.5% of patients not prescribed opioids at discharge required a new prescription before follow-up. Pain scores were 2.4±2.5 for incision site and 3.0±2.8 for overall pain (scale 0–10). Conclusions: Patient-reported post-discharge opioid use, surgical approach, and in-hospital opioid use before discharge should be used to inform prescribing recommendations after lung resection.",

keywords = "lung cancer, Opioid prescribing, practice guidelines, thoracic surgery",

author = "Mondo{\~n}edo, {Jarred R.} and Brescia, {Alexander A.} and Clark, {Melissa J.} and Chang, {Matthew L.} and Shannon Jiang and Chang He and Welsh, {Robert J.} and Popoff, {Andrew M.} and Kulkarni, {Mohan G.} and Lall, {Shelly C.} and Pratt, {Jerry W.} and Adams, {Kumari N.} and Alnajjar, {Raed M.} and Martin, {James R.} and Gandhi, {Divyakant B.} and Brummett, {Chad M.} and Chang, {Andrew C.} and Lagisetty, {Kiran H.}",

year = "2023",

month = jun,

doi = "10.21037/jtd-22-1621",

language = "English",

volume = "15",

pages = "3285--3294",

journal = "Journal of Thoracic Disease",

issn = "2072-1439",

number = "6",

}

Mondoñedo, JR, Brescia, AA, Clark, MJ, Chang, ML, Jiang, S, He, C, Welsh, RJ, Popoff, AM, Kulkarni, MG, Lall, SC, Pratt, JW, Adams, KN, Alnajjar, RM, Martin, JR, Gandhi, DB, Brummett, CM, Chang, AC & Lagisetty, KH 2023, 'Evidence-based opioid prescribing guidelines after lung resection: a prospective, multicenter analysis', Journal of Thoracic Disease, vol. 15, no. 6, pp. 3285-3294. https://doi.org/10.21037/jtd-22-1621

TY - JOUR

T1 - Evidence-based opioid prescribing guidelines after lung resection

T2 - a prospective, multicenter analysis

AU - Mondoñedo, Jarred R.

AU - Brescia, Alexander A.

AU - Clark, Melissa J.

AU - Chang, Matthew L.

AU - Jiang, Shannon

AU - He, Chang

AU - Welsh, Robert J.

AU - Popoff, Andrew M.

AU - Kulkarni, Mohan G.

AU - Lall, Shelly C.

AU - Pratt, Jerry W.

AU - Adams, Kumari N.

AU - Alnajjar, Raed M.

AU - Martin, James R.

AU - Gandhi, Divyakant B.

AU - Brummett, Chad M.

AU - Chang, Andrew C.

AU - Lagisetty, Kiran H.

PY - 2023/6

Y1 - 2023/6

N2 - Background: Opioid prescribing guidelines have significantly decreased overprescribing and post-discharge use after cardiac surgery; however, limited recommendations exist for general thoracic surgery patients, a similarly high-risk population. We examined opioid prescribing and patient-reported use to develop evidence-based, opioid prescribing guidelines after lung cancer resection. Methods: This prospective, statewide, quality improvement study was conducted between January 2020 to March 2021 and included patients undergoing surgical resection of a primary lung cancer across 11 institutions. Patient-reported outcomes at 1-month follow-up were linked with clinical data and Society of Thoracic Surgery (STS) database records to characterize prescribing patterns and post-discharge use. The primary outcome was quantity of opioid used after discharge; secondary outcomes included quantity of opioid prescribed at discharge and patient-reported pain scores. Opioid quantities are reported in number of 5-mg oxycodone tablets (mean ± standard deviation). Results: Of the 602 patients identified, 429 met inclusion criteria. Questionnaire response rate was 65.0%. At discharge, 83.4% of patients were provided a prescription for opioids of mean size 20.5±13.1 pills, while patients reported using 8.2±13.0 pills after discharge (P<0.001), including 43.7% who used none. Those not taking opioids on the calendar day prior to discharge (32.4%) used fewer pills (4.4±8.1 vs. 11.7±14.9, P<0.001). Refill rate was 21.5% for patients provided a prescription at discharge, while 12.5% of patients not prescribed opioids at discharge required a new prescription before follow-up. Pain scores were 2.4±2.5 for incision site and 3.0±2.8 for overall pain (scale 0–10). Conclusions: Patient-reported post-discharge opioid use, surgical approach, and in-hospital opioid use before discharge should be used to inform prescribing recommendations after lung resection.

AB - Background: Opioid prescribing guidelines have significantly decreased overprescribing and post-discharge use after cardiac surgery; however, limited recommendations exist for general thoracic surgery patients, a similarly high-risk population. We examined opioid prescribing and patient-reported use to develop evidence-based, opioid prescribing guidelines after lung cancer resection. Methods: This prospective, statewide, quality improvement study was conducted between January 2020 to March 2021 and included patients undergoing surgical resection of a primary lung cancer across 11 institutions. Patient-reported outcomes at 1-month follow-up were linked with clinical data and Society of Thoracic Surgery (STS) database records to characterize prescribing patterns and post-discharge use. The primary outcome was quantity of opioid used after discharge; secondary outcomes included quantity of opioid prescribed at discharge and patient-reported pain scores. Opioid quantities are reported in number of 5-mg oxycodone tablets (mean ± standard deviation). Results: Of the 602 patients identified, 429 met inclusion criteria. Questionnaire response rate was 65.0%. At discharge, 83.4% of patients were provided a prescription for opioids of mean size 20.5±13.1 pills, while patients reported using 8.2±13.0 pills after discharge (P<0.001), including 43.7% who used none. Those not taking opioids on the calendar day prior to discharge (32.4%) used fewer pills (4.4±8.1 vs. 11.7±14.9, P<0.001). Refill rate was 21.5% for patients provided a prescription at discharge, while 12.5% of patients not prescribed opioids at discharge required a new prescription before follow-up. Pain scores were 2.4±2.5 for incision site and 3.0±2.8 for overall pain (scale 0–10). Conclusions: Patient-reported post-discharge opioid use, surgical approach, and in-hospital opioid use before discharge should be used to inform prescribing recommendations after lung resection.

KW - lung cancer

KW - Opioid prescribing

KW - practice guidelines

KW - thoracic surgery

UR - http://www.scopus.com/inward/record.url?scp=85166205630&partnerID=8YFLogxK

U2 - 10.21037/jtd-22-1621

DO - 10.21037/jtd-22-1621

M3 - Article

C2 - 37426143

AN - SCOPUS:85166205630

SN - 2072-1439

VL - 15

SP - 3285

EP - 3294

JO - Journal of Thoracic Disease

JF - Journal of Thoracic Disease

IS - 6

ER -

Evidence-based opioid prescribing guidelines after lung resection: a prospective, multicenter analysis

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Keywords

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