A Safe Step Toward Opioid Stewardship: Standardized Low-Dose Discharge Opioid Prescriptions After Minimally Invasive Outpatient Appendectomy and Cholecystectomy

Abstract

Background

Opioid stewardship aims to balance effective pain control with minimizing overprescription. We hypothesized that a discharge prescription of 5 oxycodone 5 mg tablets for minimally invasive outpatient appendectomy and cholecystectomy would be associated with low rates of prescription refill and emergency department (ED) utilization for inadequate pain control.

Methods

This single-center retrospective study enrolled outpatient appendectomies and cholecystectomies between 1/25 and 6/25. Patients with oxycodone allergy or chronic opioid therapy were excluded. Primary outcome was patient-reported number of tablets taken by the first postoperative visit. Secondary outcomes included proportion of patients who utilized the NurseLine or ED for postoperative pain, proportion who requested prescription refills, and timing of contact after discharge.

Results

A total of 364 patients were included. Six patients met exclusion criteria and 90 were lost to follow-up. The median [IQR 0-5] and mode of tablets taken were 3 and 5, respectively. Fifty-six patients (21%) reported taking zero tablets. Fifteen (4%) requested prescription refills. Thirty-two patients (9% of 358) contacted the NurseLine due to inadequately treated pain. Among those, 16 (50% of 32) presented to the ED, 3 of whom received a dose of opioids. The median number of days until NurseLine contact for postoperative pain was 4 [2-8].

Discussion

A standardized opioid discharge regimen for outpatient appendectomy and cholecystectomy was associated with low ED utilization (<5%) and rare need for additional opioids (4%). The median number of oxycodone tablets taken postoperatively was 3, suggesting further room for optimization in our opioid stewardship. NurseLine counseling may further reduce ED use.