Newly Published
Education  |   March 2020
Opioid Stewardship Program and Postoperative Adverse Events: A Difference-in-differences Cohort Study
Author Notes
  • From the Department of Anesthesiology, Newton-Wellesley Hospital, Newton, Massachusetts (A.M.B.); the Department of Anesthesiology, Rush University Medical Center, Chicago, Illinois (R.J.M., A.B.); the Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania (N.E.); the Anesthesiology and Perioperative Care Service, Department of Veterans Affairs Palo Alto Health Care System, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California (E.R.M.); the Department of Anesthesiology and Perioperative Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire (B.S.); and Premier, Inc., Premier Government Services, Charlotte, North Carolina (R.G.).
  • Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).
    Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).×
  • Part of the work presented in this article has been presented at the National Rx Drug Abuse and Heroin Summit in Atlanta, Georgia, April 5, 2018, and April 25, 2019.
    Part of the work presented in this article has been presented at the National Rx Drug Abuse and Heroin Summit in Atlanta, Georgia, April 5, 2018, and April 25, 2019.×
  • Submitted for publication August 2, 2019. Accepted for publication February 11, 2020.
    Submitted for publication August 2, 2019. Accepted for publication February 11, 2020.×
  • Correspondence: Address correspondence to Dr. McCarthy: Department of Anesthesiology, Rush University Medical Center, 1650 W. Congress Parkway, Chicago, Illinois 60612. Robert_J_McCarthy@rush.edu. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Education / Pain Medicine / Pharmacology / Quality Improvement / Opioid
Education   |   March 2020
Opioid Stewardship Program and Postoperative Adverse Events: A Difference-in-differences Cohort Study
Anesthesiology Newly Published on March 10, 2020. doi:https://doi.org/10.1097/ALN.0000000000003238
Anesthesiology Newly Published on March 10, 2020. doi:https://doi.org/10.1097/ALN.0000000000003238
Abstract

Background: A 6-month opioid use educational program consisting of webinars on pain assessment, postoperative and multimodal pain opioid management, safer opioid use, and preventing addiction coupled with on-site coaching and monthly assessments reports was implemented in 31 hospitals. The authors hypothesized the intervention would measurably reduce and/or prevent opioid-related harm among adult hospitalized patients compared to 33 nonintervention hospitals.

Methods: Outcomes were extracted from medical records for 12 months before and after the intervention start date. Opioid adverse events, evaluated by opioid overdose, wrong substance given or taken in error, naloxone administration, and acute postoperative respiratory failure causing prolonged ventilation were the primary outcomes. Opioid use in adult patients undergoing elective hip or knee arthroplasty or colorectal procedures was also assessed. Differences-in-differences were compared between intervention and nonintervention hospitals.

Results: Before the intervention, the incidence ± SD of opioid overdose, wrong substance given, or substance taken in error was 1 ± 0.5 per 10,000 discharges, and naloxone use was 117 ± 13 per 10,000 patients receiving opioids. The incidence of respiratory failure was 42 ± 10 per 10,000 surgical discharges. A difference-in-differences of –0.2 (99% CI, –1.1 to 0.6, P = 0.499) per 10,000 in opioid overdose, wrong substance given, or substance taken in error and –13.6 (99% CI, –29.0 to 0.0, P = 0.028) per 10,000 in respiratory failure was observed postintervention in the intervention hospitals; however, naloxone administration increased by 15.2 (99% CI, 3.8 to 30.0, P = 0.011) per 10,000. Average total daily opioid use, as well as the fraction of patients receiving daily opioid greater than 90 mg morphine equivalents was not different between the intervention and nonintervention hospitals.

Conclusions: A 6-month opioid educational intervention did not reduce opioid adverse events or alter opioid use in hospitalized patients. The authors’ findings suggest that despite opioid and multimodal analgesia awareness, limited-duration educational interventions do not substantially change the hospital use of opioid analgesics.

Editor’s Perspective:

What We Already Know about This Topic:

  • Education may promote safer opioid use in hospitals

What This Article Tells Us That Is New:

  • The investigators conducted a difference-in-differences analysis before and after implementation of opioid training in 31 intervention hospitals and 33 nonintervention hospitals

  • The 6-month-long opioid education consisted of webinars on pain assessment, multimodal analgesia, and safer opioid use

  • The educational initiative did not substantively change opioid use