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Guideline-Directed Prescribing and Proper Disposal of Excess Opioids After Inpatient Surgery: A Prospective Clinical Trial
Eleah D Porter1, *Ilda B Molloy1, *Sarah Y Bessen2, *Julia L Kelly1, Richard J Barth1
1Dartmouth-Hitchcock Medical Center, Lebanon, NH;2Geisel School of Medicine, Hanover, NH

Objective: 1. To prospectively validate guidelines for discharge opioid prescriptions after inpatient surgery. 2. To increase the proportion of patients who dispose of excess opioids using an FDA-compliant method, which previous studies have shown to be less than 20%. Design: Prospective clinical trial. Setting: Academic medical center. Patients: 229 adult patients admitted for ≥48-hours after elective general, urologic, gynecologic or thoracic surgery. Interventions: 1. Discharge opioid prescription determined by number of pills used the day prior to discharge: 0 oxycodone pill equivalents used, five (5mg) pill equivalents prescribed; 1-3 pills used, 15 prescribed; >4 pills used, 30 prescribed. 2. Promoted FDA-compliant disposal of excess pills by a) patient education session, b) reminder phone call, c) convenient drop box located in hospital pharmacy, and d) follow-up questionnaire. Main Outcome Measures: 1. Rate of satisfactory pain control (no refills obtained). 2. Proportion of FDA-compliant disposal of excess pills. Results: Guidelines satisfied 93% (213/229) of patients’ pain needs. For patients using no opioids the day prior to discharge, 5 oxycodone pill equivalents satisfied 99% (99/100). For those using 1-3 pills, 15 pills satisfied 90% (92/102). For those using >4 pills, 30 pills satisfied 81% (22/27). 60% (138/229) of patients had leftover pills (21% [48/229] never filled their prescription and 19% [43/229] used it entirely). 83% (114/138) of patients with excess pills disposed of them using an FDA-compliant method. Of those patients, 51% (58/114) utilized the hospital pharmacy drop box. Of 2,594 total opioid pills prescribed, only 187 excess pills (7%) were kept by patients. Conclusions: Postoperative opioid use the day prior to discharge predicts outpatient needs. FDA-compliant disposal of excess pills can be optimized with easily actionable interventions.


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