How Michigan Medicine reduced opioid use 60% for gallbladder surgery patients

Evidence-based opioid prescribing guidelines developed by researchers at the University of Michigan in Ann Arbor reduced the number of opioids prescribed after gallbladder removal surgery by more than 60 percent, according to a study published in JAMA Surgery.

To establish the guidelines, researchers analyzed data on 170 laparoscopic cholecystectomy patients. The team contacted 100 of these patients within one year of their surgery to find out how many opioids they'd used to address post-surgical pain. While the patients were prescribed about 250 milligrams of opioids post-surgery, they only used about 30 milligrams on average.

Researchers also asked patients about their nonopioid pain medication use and the level of pain they experienced one week after surgery. Based upon these responses, researchers developed new prescribing guidelines, which called for a more than 60 percent reduction in prescribed opioids and an increased emphasis of nonopioid pain medication. The guidelines took effect at Michigan Medicine in November 2016.

To assess the impact of the guidelines, researchers surveyed 86 additional gallbladder surgery patients treated after the intervention. Participants reported increased use of nonopioid painkillers like acetaminophen, but no increase in the need for opioid refills. Average pain scores remained stable. Ultimately, the new guidelines prevented 7,000 excess opioid pills from being prescribed with no change in the quality of pain management.

"For a long time, there has been no rhyme or reason to surgical opioid prescribing, compared with all the other efforts that have been made to improve surgical care," said Ryan Howard, MD, a resident in the U-M Department of Surgery and the study's first author. "We've been overprescribing because no one had ever really asked what's the right amount. We knew we could do better … We hope that this framework we've developed can be applied to many more operations."

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