Skip to main content
Journal cover image

The Impact of Education and Prescribing Guidelines on Opioid Prescribing for Breast and Melanoma Procedures.

Publication ,  Journal Article
Lee, JS; Howard, RA; Klueh, MP; Englesbe, MJ; Waljee, JF; Brummett, CM; Sabel, MS; Dossett, LA
Published in: Ann Surg Oncol
January 2019

BACKGROUND: Excessive opioid prescribing is common in surgical oncology, with 72% of prescribed opioids going unused after curative-intent surgery. In this study, we sought to reduce opioid prescribing after breast and melanoma procedures by designing and implementing an intervention focused on education and prescribing guidelines, and then evaluating the impact of this intervention. METHODS: In this single-institution study, we designed and implemented an intervention targeting key factors identified in qualitative interviews. This included mandatory education for prescribers, evidence-based prescribing guidelines, and standardized patient instructions. After the intervention, interrupted time-series analysis was used to compare the mean quantity of opioid prescribed before and after the intervention (July 2016-September 2017). We also evaluated the frequency of opioid prescription refills. RESULTS: During the study, 847 patients underwent breast or melanoma procedures and received an opioid prescription. For mastectomy or wide local excision for melanoma, the mean quantity of opioid prescribed immediately decreased by 37% after the intervention (p = 0.03), equivalent to 13 tablets of oxycodone 5 mg. For lumpectomy or breast biopsy, the mean quantity of opioid prescribed decreased by 42%, or 12 tablets of oxycodone 5 mg (p = 0.07). Furthermore, opioid prescription refills did not significantly change for mastectomy/wide local excision (13% vs. 14%, p = 0.8), or lumpectomy/breast biopsy (4% vs. 5%, p = 0.7). CONCLUSION: Education and prescribing guidelines reduced opioid prescribing for breast and melanoma procedures without increasing the need for refills. This suggests further reductions in opioid prescribing may be possible, and provides rationale for implementing similar interventions for other procedures and practice settings.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

Ann Surg Oncol

DOI

EISSN

1534-4681

Publication Date

January 2019

Volume

26

Issue

1

Start / End Page

17 / 24

Location

United States

Related Subject Headings

  • Prognosis
  • Practice Patterns, Physicians'
  • Practice Guidelines as Topic
  • Pain, Postoperative
  • Oncology & Carcinogenesis
  • Oncologists
  • Melanoma
  • Mastectomy
  • Inappropriate Prescribing
  • Humans
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Lee, J. S., Howard, R. A., Klueh, M. P., Englesbe, M. J., Waljee, J. F., Brummett, C. M., … Dossett, L. A. (2019). The Impact of Education and Prescribing Guidelines on Opioid Prescribing for Breast and Melanoma Procedures. Ann Surg Oncol, 26(1), 17–24. https://doi.org/10.1245/s10434-018-6772-3
Lee, Jay S., Ryan A. Howard, Michael P. Klueh, Michael J. Englesbe, Jennifer F. Waljee, Chad M. Brummett, Michael S. Sabel, and Lesly A. Dossett. “The Impact of Education and Prescribing Guidelines on Opioid Prescribing for Breast and Melanoma Procedures.Ann Surg Oncol 26, no. 1 (January 2019): 17–24. https://doi.org/10.1245/s10434-018-6772-3.
Lee JS, Howard RA, Klueh MP, Englesbe MJ, Waljee JF, Brummett CM, et al. The Impact of Education and Prescribing Guidelines on Opioid Prescribing for Breast and Melanoma Procedures. Ann Surg Oncol. 2019 Jan;26(1):17–24.
Lee, Jay S., et al. “The Impact of Education and Prescribing Guidelines on Opioid Prescribing for Breast and Melanoma Procedures.Ann Surg Oncol, vol. 26, no. 1, Jan. 2019, pp. 17–24. Pubmed, doi:10.1245/s10434-018-6772-3.
Lee JS, Howard RA, Klueh MP, Englesbe MJ, Waljee JF, Brummett CM, Sabel MS, Dossett LA. The Impact of Education and Prescribing Guidelines on Opioid Prescribing for Breast and Melanoma Procedures. Ann Surg Oncol. 2019 Jan;26(1):17–24.
Journal cover image

Published In

Ann Surg Oncol

DOI

EISSN

1534-4681

Publication Date

January 2019

Volume

26

Issue

1

Start / End Page

17 / 24

Location

United States

Related Subject Headings

  • Prognosis
  • Practice Patterns, Physicians'
  • Practice Guidelines as Topic
  • Pain, Postoperative
  • Oncology & Carcinogenesis
  • Oncologists
  • Melanoma
  • Mastectomy
  • Inappropriate Prescribing
  • Humans