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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 12/2020

01-11-2020 | Paracetamol | Breast Oncology

Changing the Default: A Prospective Study of Reducing Discharge Opioid Prescription after Lumpectomy and Sentinel Node Biopsy

Authors: Tracy-Ann Moo, MD, Kate R. Pawloski, MD, Varadan Sevilimedu, MBBS, DrPH, Jillian Charyn, BA, Brett A. Simon, MD, PhD, Lisa M. Sclafani, MD, George Plitas, MD, Andrea V. Barrio, MD, Laurie J. Kirstein, MD, Kimberly J. Van Zee, MS, MD, Monica Morrow, MD

Published in: Annals of Surgical Oncology | Issue 12/2020

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Abstract

Background

Whether routinely prescribed opioids are necessary for pain control after discharge among lumpectomy/sentinel node biopsy (Lump/SLNB) patients is unclear. We hypothesize that Lump/SLNB patients could be discharged without opioids, with a failure rate < 10%. This study prospectively examines outcomes after changing standard discharge prescription from an opioid/non-steroidal anti-inflammatory drug (NSAID) to NSAID/acetaminophen.

Patients and Methods

Standard discharge pain medication orders included opioids in the first 3-month study period and were changed to NSAID/acetaminophen in the second 3-month period. Patient-reported medication consumption and pain scores were collected by post-discharge survey. Frequency of discharge with opioid, NSAID/acetaminophen failure rate, opioid use, and pain scores were examined.

Results

From May to October 2019, 663 patients had Lump/SLNB: 371 in the opioid study period and 292 in the NSAID period. In the opioid period, 92% (342/371) of patients were prescribed an opioid at discharge; of 142 patients who documented opioid use on the survey, 86 (61%) used zero tablets. Among 56 (39%) patients who used opioids, the median number taken by POD 5 was 4. After the change to NSAID/acetaminophen, rates of opioid prescription decreased to 14% (41/292). The NSAID/acetaminophen failure rate was 2% (5/251). Among survey respondents, there was no significant difference in the maximum reported pain scores (POD 1–5) between the opioid period and the NSAID period (p = 0.7).

Conclusions

In Lump/SLNB patients, a change to default discharge with NSAID/acetaminophen resulted in a 78% absolute reduction in opioid prescription, with a failure rate of 2% and no difference in patient-reported pain scores. Most Lump/SLNB patients can be discharged with NSAID/acetaminophen.
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Metadata
Title
Changing the Default: A Prospective Study of Reducing Discharge Opioid Prescription after Lumpectomy and Sentinel Node Biopsy
Authors
Tracy-Ann Moo, MD
Kate R. Pawloski, MD
Varadan Sevilimedu, MBBS, DrPH
Jillian Charyn, BA
Brett A. Simon, MD, PhD
Lisa M. Sclafani, MD
George Plitas, MD
Andrea V. Barrio, MD
Laurie J. Kirstein, MD
Kimberly J. Van Zee, MS, MD
Monica Morrow, MD
Publication date
01-11-2020
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 12/2020
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-020-08886-9

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