Evaluation of Opioid Prescribing in Coronary Artery Bypass Patients Following an Opioid Stewardship Intervention

Purpose: Post-surgical opioid discharge prescriptions have a wide variation in prescribing patterns, including the type of opioid, quantity of pills, and daily morphine milligram equivalents prescribed. Opioid stewardship can help in promoting safe and effective use of opioids to optimize pain control and minimize unintended negative consequences. With the growing implementation of opioid stewardship programs, it is necessary to evaluate pain management practices to ensure positive patient outcomes. The purpose of this study is to assess differences in post-operative opioid discharge prescribing in patients undergoing coronary artery bypass graft following implementation of a tripartite opioid stewardship intervention. Methods: The study was a single-center, pre-post study that evaluated the effect of a tripartite opioid stewardship intervention on discharge opioid prescribing practices at a large, quaternary academic medical center. Adult patients receiving coronary artery bypass graft (CABG) surgery from July 2019- June 2020 (pre-intervention) and November 2020-February 2021 (post-intervention) were included. The intervention, which was implemented from September 2020-October 2020, included adopting hospital wide post-surgical opioid discharge prescribing guidelines, discharge prescriber education, and electronic medical record changes to reduce default amounts for outpatient opioid prescriptions. The primary outcome measure was the proportion of CABG patients receiving an opioid prescription at discharge. Secondary outcomes include total Morphine Milligram Equivalents prescribed per CABG patient at discharge, the proportion of CABG patients prescribed non-opioid analgesics at discharge, and the duration of opioids prescribed in days at discharge. A chi-squared test was used to determine statistical significance for categorical variables and the t-test was used to determine statistical significance for continuous variables. Multivariable logistic regression was used to assess the factors associated with receiving an opioid at discharge. Results: A total of 156 patients were included in the study; 100 patients pre-intervention and 56 patients post-intervention. There was no difference in opioid discharge prescribing between the two groups (74.0% pre-intervention vs. 62.5% post-intervention; p = 0.148). For those patients who received an opioid prescription at discharge, there no difference in MMEs at discharge (154.9 ± 55.8 pre- vs. 166 ± 98 post-; p = 0.364). No difference was seen in non-opioid analgesic prescriptions prescribed at discharge (35.0% pre- vs. 44.6% post-; p =0.303). There was no difference in opioid prescriptions days’ supply (5.6 ± 1.7 pre- vs. 5.8 ± 1.8 post-; p = 0.723). Conclusion: A multipronged opioid stewardship intervention did not lead to a reduction in opioid prescribing at discharge. Post-intervention there was a non-statistically significant increase in the proportion of on-opioid analgesics prescribed at discharge. Future studies should assess the effect of different stewardship interventions on prescribing and patient outcomes.