Standardized guidelines reduce overprescribing of opioids after ophthalmic surgery

Overprescribing of opioids after ophthalmic surgery can be reduced without increasing refill rates by standardizing opioid prescribing guidelines and discussing postsurgical pain management, suggests a recent study. Continued education is also needed to improve adherence to the prescribing guidelines.

This quality improvement study compared postoperative opioid prescribing patterns before and after the implementation of standardized opioid prescribing guidelines for ophthalmic surgery at an academic institution. Only prescriptions provided to opioid-naïve patients aged ≥18 years were included.

Ophthalmic surgeons reached a consensus for standardized prescribing guidelines appropriate for the surgery type within their subspecialty. They disseminated the guidelines in combination with postsurgical pain management education to all ophthalmologists in the department, including trainees.

Of the 5,349 surgeries performed during the two assessment periods, 196 (3.7 percent) were related to opioid prescriptions for acute postoperative pain. The frequency of opioid prescriptions decreased from 4.4 percent (115/2,613) before the intervention to 3.0 percent (81/2,736) after the intervention (p=0.005).

The mean oral morphine equivalent (OME) when opioid were prescribed also decreased from 93 (range, 27–500) before the intervention to 42 (range, 14–100) after the intervention (p=0.003). A reduction was also observed in the number of prescriptions for more than 80 OME, from 56 (2.1 percent) to 4 (0.1 percent; p<0.001).

Based on the standardized guidelines, 103 of 115 (89.6 percent) preintervention opioid prescriptions would not have adhered to the guidelines, while 39 of the 81 (48.1 percent) postintervention prescriptions did not adhere to the guidelines (p<0.001). There was no difference in the refill rates before and after the intervention (p=0.44).