Impact of an Australian/New Zealand organisational position statement on extended-release opioid prescribing among surgical inpatients: a dual centre before-and-after study

R. Awadalla, S. Liu, A. Kemp-Casey, D. Gnjidic, A. Patanwala, J. Stevens, D. Begley, B. Bugeja, J. Penm

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

Abstract

Extended-release opioids are often prescribed to manage postoperative pain despite being difficult to titrate to analgesic requirements and their association with long-term opioid use. An Australian/New Zealand organisational position statement released in March 2018 recommended avoiding extended-release opioid prescribing for acute pain. This study aimed to evaluate the impact of this organisational position statement on extended-release opioid prescribing among surgical inpatients. Secondary objectives included predictors and clinical outcomes of prescribing extended-release opioids among surgical inpatients. We conducted a retrospective, dual centre, 11-month before-and-after study and time-series analysis by utilising electronic medical records from two teaching hospitals in Sydney, Australia. The primary outcome was the proportion of patients prescribed an extended-release opioid. For surgical patients prescribed any opioid (n = 16,284), extended-release opioid prescribing decreased after the release of the position statement (38.4% before vs. 26.6% after, p < 0.001), primarily driven by a reduction in extended-release oxycodone (31.1% before vs. 14.1% after, p < 0.001). There was a 23% immediate decline in extended-release opioid prescribing after the position statement release (p < 0.001), followed by an additional 0.2% decline per month in the following months. Multivariable regression showed that the release of the position statement was associated with a decrease in extended-release opioid prescribing (OR 0.54, 95%CI 0.50–0.58). Extended-release opioid prescribing was also associated with increased incidence of opioid-related adverse events (OR 1.52, 95%CI 1.35–1.71); length of stay (RR 1.44, 95%CI 1.39–1.51); and 28-day re-admission (OR 1.26, 95%CI 1.12–1.41). Overall, a reduction in extended-release opioid prescribing was observed in surgical inpatients following position statement release.

Original languageEnglish (US)
Pages (from-to)1607-1615
Number of pages9
JournalAnaesthesia
Volume76
Issue number12
DOIs
StatePublished - Dec 2021

Keywords

  • extended-release opioid
  • long-acting opioid
  • opioid epidemic
  • opioid prescription
  • opioids
  • position statement

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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