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Every step counts, right?
The University of Texas MD Anderson Cancer Center took that incremental approach to reduce inpatient opioid use following pancreatic cancer surgery by over 50%, the Houston-based system announced Wednesday.
Between 2018 and 2022, researchers at the center’s surgical oncology department increased the rate of opioid-free discharges to 52.5%, up from 7.2%, and 77.9% of patients were discharged with fewer than 50 mg of oral morphine equivalents (OME), which is less than 10 pills.
Prior to the study of 832 patients undergoing pancreatic resection surgery, the OME median was 150 mg at time of discharge, according to the system. (OME, for the layperson, is a conversion metric to compare different types of oral morphine, according to MD Anderson).
“Patients not regularly taking opioids are at risk of developing a new dependence after surgery, and excess pills also create a risk of misuse by family members or others in their community,” Ching-Wei Tzeng, a senior author of the study and an associate professor of surgical oncology, said in a statement. “Pancreatic cancer surgery can be a painful operation with a difficult recovery. This study shows that, even in this setting, easy-to-implement strategies can achieve effective pain control for our patients without putting them at risk for opioid dependence.”
Low-risk and low-cost nonopioids, such as muscle relaxers and anti-inflammatories, replaced OMEs in the study and still effectively managed patient pain for a surgery that’s “considered one of the most complex abdominal operations a patient might undergo.”
“Median pain scores remained less than or equal to three out of 10 in all cohorts, with no differences in post-discharge refill requests […] and most patients did not require opioid refills after discharge,” according to MD Anderson.
“Our enhanced recovery program, which includes generalizable protocols to reduce reliance on opioid medications, is the first to demonstrate continuous decreases in opioid use and distribution after pancreatic surgery,” Tzeng said in a statement. “By making purposeful, successive improvements to existing processes, we showed that we can reduce the amount of opioids patients need after a major surgery while ensuring they recover well without any extra costs.”