Abstract
Objective: To evaluate an opioid stewardship prescribing guideline change aimed at reducing overprescribing of opioids in orthopedic hand surgery patients undergoing ganglion excision, trigger finger release and carpal tunnel release surgeries.|Background: Orthopedic surgery patients are well recognized as having acute pain management needs. In the United States, opioid trends of misuse, abuse, and death have placed national attention on responsible prescribing practices that assure both adequate pain control as well as recognition that over-prescribing opioids add to the risk for opioid-related morbidity and mortality. Multiple guidelines recommend correlation of prescribing with evidence of actual opioid use.|Methods: An 11 question Patient DATA Collection Survey was used for quality improvement in evaluation of opioid stewardship guideline changes. Patients who had undergone mass excision, carpal tunnel release, and trigger finger release from both Phase 1 and Phase 2 of the opioid stewardship prescribing guideline were asked to provide feedback related to their experience with post-operative pain control.|Results: There was a 63% response rate. During the Phase 1 guideline period, we found post-operative use of opioids in the carpal tunnel, mass excision, and trigger finger release groups was less than prescribed (average 8.2 tablets), 3 tablets, 6.4 tablets, and 1.75 tablets respectively. Patients in the Phase 2 guideline period were prescribed an average of 5.8 tablets and used on average 2.8 tablets (carpal tunnel), 1 tablet (trigger release), and 1.7 tablets (mass excisions). Overall prescription size decreased by 18%, with a reported prescription use of 47% in Phase 1 and 52% in Phase 2. Despite a significant reduction in prescription size, patient satisfaction was overwhelmingly positive with no patients reporting that their opioid prescription size was insufficient.|Conclusion: Post-operative data collection on patient reported opioid use following surgery provided insight into actual opioid use and requirements following surgery. This allowed for prescribers to review their prescribing habits, adherence to guidelines, and adequacy of the pain control following surgery. This data could also help modify prescription size, which fulfills the needs of patients, while limiting excess prescriptions, which are associated with abuse and misuse.