Guideline-Based Prescribing Associated With Lower Opioid Dosing in Hernia Repair

This study found evidence supporting patient-tailored guideline-based opioid prescribing protocols for patients undergoing ventral hernia repair.

Patients who received guideline-based opioid prescribing following ventral hernia repair were discharged with lower-dose opioid prescriptions compared with patients who received standard care, according to the results of a study published in the Journal of Surgical Research.

Investigators from Clemson University and the University of South Carolina School of Medicine Greenville sourced data for this study from Prisma Health Upstate. Patients (N=163) who underwent ventral hernia repair between 2018 and 2019 were retrospectively reviewed for opioid prescribing at discharge on the basis of whether they received patient-tailored, guideline-based prescribing.

The guideline-prescribing protocols were to prescribe patients who consumed 0 to 5 milligram morphine equivalents (MME) 24 hours prior to discharge a dose of 15 MME, those who consumed 6 to 15 MME were to be prescribed a discharge dose of 40 MME, those who consumed 16 to 30 MME were to be prescribed a discharge dose of 80 MME, and those who consumed more than 30 MME were to be prescribed a discharge dose of 100 MME. Patients who received standard care were prescribed a discharge dose greater than that indicated by the guideline.

The mean age of the patient population was 58.72±12.44 years, 87.73% were White, 73.62% had American Society of Anesthesiologists class 3 status, 41.72% underwent recurrent hernia repair, 60.12% underwent open surgery, 82.21% received a transverse abdominis plane block, the median hospital length of stay was 48 (interquartile range [IQR], 30-56) hours, and 7.98% experienced postoperative complications. The standard care and guideline-based care cohorts were well balanced at baseline.

[W]e found no differences in pain control or quality-of-life scores after discharge, indicating the amount of opioids prescribed under the guideline were sufficient for patients.

Overall median opioid consumption was 17.50 (IQR, 5.00-33.20) MME 24 hours before discharge. The guideline-based cohort consumed a greater opioid dose than the standard care group in the 24 hours before discharge (median, 23.25 vs 12.00 MME; P =.01).

The guideline-based (n=42) and standard (n=121) care groups received a discharge opioid prescription with a median dose of 65.00 and 100.00 MME (P <.0001), 19.05% and 13.22% refilled their prescription within 30 days (P =.3587), the refill prescription had a dose of 75.00 and 150.00 MME (P =.1085), and total discharge opioid prescription with refill was 75.00 and 112.50 MME (P =.0013), respectively.

In the logistic regression analysis, postdischarge opioid refill was associated with postoperative complications (odds ratio [OR], 11.36; 95% CI, 2.24-57.57; P <.01) and obesity (OR, 0.20; 95% CI, 0.06-0.64; P =.01).

No differences in patient-reported pain (P =.8169) or quality of life (P =.3073) outcomes were observed among the 2 groups.

Limitations of this study include its retrospective, single-center design and small sample size.

The study investigators found evidence supporting the patient-tailored, guideline-based opioid prescribing protocols for patients undergoing ventral hernia repair, in which despite consuming higher doses of opioids in the 24 hours before discharge, the guideline-based protocols were associated with lower opioid dosing without affecting patient-reported outcomes. The study authors conclude, “[We] found no differences in pain control or quality-of-life scores after discharge, indicating the amount of opioids prescribed under the guideline were sufficient for patients.”

References:

Lindros SH, Warren JA, Carbonell AM, Cobb WS IV, Floyd SB. Implementation of a patient-tailored opioid prescribing guideline in ventral hernia surgery. J Surg Res. 2022;282:109-117. doi:10.1016/j.jss.2022.09.021