Patients prescribed fewer opioid pills after undergoing major gynecologic surgery, without detrimental effect
- Team revised post-surgery pain-management protocol for more than 300 patients
- Dispensed opioids reduced 89% overall, and 97% for minimally invasive surgeries
- Findings presented at plenary session of SGO Annual Meeting on Women’s Cancer
BUFFALO, N.Y. — New research from Roswell Park Comprehensive Cancer Center suggests that medical care providers are able to significantly reduce use of opioid painkillers through a two-step process: providing fewer opioids to patients upon their discharge following surgery, and supporting good communication between the clinical team and the patient. The results, first presented this morning in a plenary session at the Society of Gynecologic Oncology (SGO) Annual Meeting on Women’s Cancer, suggest that clinical teams may be routinely overprescribing opioids, and provide evidence that more restrictive approaches to pain management for surgical patients can be highly effective.
The Roswell Park research team investigated this innovative approach to pain management through a 19-month study in patients undergoing major gynecologic surgeries. Led by Emese Zsiros, MD, PhD, FACOG, Assistant Professor of Oncology with the Department of Gynecologic Oncology and Center for Immunotherapy, the research team did a prospective analysis, comparing data on the experiences of 337 patients treated from June 2017 through January 2018 to a control group of 626 cases from prior years.
The majority of patients — those undergoing ambulatory or minimally invasive surgery and who did not have a history of chronic pain — were not issued any opioids upon discharge, and those undergoing open surgery received a three-day rather than a seven-day supply of prescription opioids. Patient education processes and messaging were updated to reflect the revised protocol and to encourage patients to contact their clinical team if their pain was not managed or they had questions or concerns.
The researchers showed that they were able to reduce use of opioids by 89%, from 31.7 to 3.5 opioid tablets, on average, overall among all patients and by 97%, from 28.1 to .9 tablets, on average, in patients whose surgeries were minimally invasive or ambulatory, meaning no inpatient admission was required. The numbers of patients requesting opioid refills within 30 days of surgery decreased, and even those patients with a history of chronic pain saw their need for opioids reduced by 83% compared to the control group.
“We were quite surprised by how few inquiries and requests for medication we got from our patients,” says Jaron Mark, MD, a clinical fellow at Roswell Park who presented the research at SGO today. “We expected that we’d be able to reduce use of opioids without detrimental consequences, but the extent to which our hypothesis was supported by these results was really striking.”
Decreasing the number of unused circulating opioid pills in the community could significantly reduce the chance for opioid misuse, abuse and diversion, the researchers note.
“I think the key to our experience here was setting expectations about pain management in advance — with both the clinical team and with our patients,” adds Dr. Zsiros. “It actually might take a little more time and effort by the clinical team to prescribe fewer doses of pain medication, but our results show that those efforts are well worth it in terms of reducing the likelihood of long-term opioid dependence or abuse.”
The researchers expect to pursue further research exploring the implications of this study.
Roswell Park Comprehensive Cancer Center is a community united by the drive to eliminate cancer’s grip on humanity by unlocking its secrets through personalized approaches and unleashing the healing power of hope. Founded by Dr. Roswell Park in 1898, it is the only National Cancer Institute-designated comprehensive cancer center in Upstate New York. Learn more at www.roswellpark.org, or contact us at 1-800-ROSWELL (1-800-767-9355) or ASKRoswell@roswellpark.org.
Annie Deck-Miller, Senior Media Relations Manager