Tailored Opioid Prescribing in Gynecologic Oncology: Michigan Prescription Opioid Reduction Tool (MiPORT)
Objectives: To evaluate the implementation of a Gynecologic Oncology quality-improvement intervention aimed at tailoring opioid prescriptions to meet individual patient needs whilst not overprescribing.
Methods: Our previously published opioid prescribing algorithm was implemented on January 1, 2021. This opioid reduction tool accounts for patient age, risk factors for opioid usage (history of anxiety, depression, substance abuse, chronic pain, or current opioid use), surgical modality, and inpatient opioid usage. This tool was used preoperatively to generate individualized opioid prescriptions for patients who underwent minimally invasive surgery or laparotomy by the Gynecologic Oncology service. Patients completed a 30-day postoperative standard questionnaire regarding the number of opioid pills used and any opioid refill requests. Opioid refill requests were cross-referenced with the state department’s automated prescription system. Patients were identified in our institution’s prospectively curated quality improvement surgical database from January 1, 2021, through July 31, 2021. Patients were included if they received the 5 mg oxycodone pills as per the standardized opioid prescribing algorithm. Prescriber compliance was defined as not prescribing more than the predicted patient needs determined by the opioid calculator. An excessive prescription was defined as the patient reporting more than three pills remaining after 30 days.
Results: Two-hundred and thirteen patients were included in the analysis, where 56% (n=119) underwent laparoscopy, and 44% (n=94) underwent laparotomy. Eighty-three patients (39%) had at least one risk factor for opioid usage. The median number of opioid pills prescribed following laparotomy was 6 (range: 0-16), and the median after laparoscopy was three pills (range: 0-15). The rate of prescriber compliance was 87% (n=185/213). Of the 28 patients who received a higher number of opioid pills than what was recommended by the opioid calculator, 19 (68%) patients received only 1-3 pills more than the recommended amount. Four patients received larger amounts (10 pills) early in the implementation of the program and five larger prescriptions due to patient requests. The 30-day opioid refill request rate was 8% (n=17/213). Of the patients who received a larger prescription, 14% (n=4/28) received an opioid refill within 30 days. Thirty-four (21%) patients had more than three pills remaining after 30 days (excessive prescription rate).
Conclusions: Using this tailored opioid calculator led to a high pre-scriber compliance rate and a low refill request rate while limiting the number of excessive opioid prescriptions.
Straubhar A, de Bear O, Stroup C, Dalton L, Reynolds RK, McLean K, et al. [McCool K]. Tailored opioid prescribing in gynecologic oncology: Michigan prescription opioid reduction tool (MiPORT). Gynecol Oncol. 2022 Aug;166(Suppl 1):S154-S155. doi: 10.1016/S0090-8258(22)01513-X.