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• W3190702245 abstract "You have accessJournal of UrologyHealth Services Research: Quality Improvement & Patient Safety II (MP34)1 Sep 2021MP34-12 INTERVENTIONS TO REDUCE POSTOPERATIVE OPIOID PRESCRIPTIONS AFTER UROLOGIC SURGERY: A SYSTEMATIC REVIEW AND META-ANALYSIS Kevin Carnes, Zorawar Singh, Ashar Ata, and Badar Mian Kevin CarnesKevin Carnes More articles by this author , Zorawar SinghZorawar Singh More articles by this author , Ashar AtaAshar Ata More articles by this author , and Badar MianBadar Mian More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002043.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Opioid prescriptions (opioid-Rx) given at hospital discharge are a major contributor to the dissemination of opioids in the community and the opioid abuse epidemic. In recent years, concerted efforts have been made to limit the opioid-Rx at discharge after surgery. We conducted a systematic review of literature (PROSPERO CRD42021226083) to identify the type of interventions used and the extent of opioid-Rx reduction after urologic surgery. METHODS: A systematic review of literature was conducted (within PRISMA guidelines) using Medline, Web of Science, and Cochrane databases to identify studies of opioids and urologic surgery. The final inclusion criterion was the availability of opioid-Rx data before (pre-int) and after an intervention (post-int) to limit opioid-Rx (in morphine milligrams equivalents, MME) given at discharge. Of the 3,139 initially identified studies, 18 studies met the inclusion criteria for the qualitative assessment and 10 studies provided detailed data for inclusion in the meta-analysis using random-effects inverse-variance model. The types of interventions were classified as either direct (e.g. provider/patient education, standardized prescription guidelines, and enhanced recovery after surgery protocols) or indirect (e.g. State mandated limits or education). RESULTS: Of the 18 studies (8,407 patients), 15 utilized direct interventions and 3 utilized indirect interventions to assess opioid-Rx at discharge. Nine studies included major/cancer surgery, 7 studies consisted of endoscopic or minor procedures, and 2 included both types of procedures. Overall, the difference in pre-int and post-int opioid-Rx per patient ranged from +3 to -246 MME or +1% to -100%; for major surgery, +1.07 % to -94.94%, and for endo/minor from -30.87% to -100%. In pooled analysis of 10 studies (5,031 patients), the mean reduction in opioid-Rx at discharge was -70.49 MME [95%CI: -91.95 to -49.83, p-value<.0001]. There was significant heterogeneity and variability in the quality of data amongst the studies (Cochrane Q 261.39, p<0.001; I2 96.6%, 71.1%-98.8%). CONCLUSIONS: Wide range of interventions have been successfully utilized to reduce opioid-Rx at discharge after major and minor urologic surgery. A clearly superior strategy to reduce opioid-Rx could not be identified. However, this analysis suggests that additional opportunities may exist to further decrease opioid-Rx at discharge, as evidenced by significant variability in effect noted amongst the studies. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e620-e621 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kevin Carnes More articles by this author Zorawar Singh More articles by this author Ashar Ata More articles by this author Badar Mian More articles by this author Expand All Advertisement Loading ..." @default.
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• W3190702245 title "MP34-12 INTERVENTIONS TO REDUCE POSTOPERATIVE OPIOID PRESCRIPTIONS AFTER UROLOGIC SURGERY: A SYSTEMATIC REVIEW AND META-ANALYSIS" @default.
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