The Standardization of Outpatient Procedure (STOP) Narcotics after anorectal surgery: a prospective non-inferiority stud
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ORIGINAL ARTICLE
The Standardization of Outpatient Procedure (STOP) Narcotics after anorectal surgery: a prospective non‑inferiority study to reduce opioid use L. B. Hartford1 · P. B. Murphy1 · D. K. Gray1 · A. Maciver1 · C. F. M. Clarke2 · L. J. Allen1 · C. Garcia‑Ochoa1 · K. A. Leslie1 · J. A. M. Van Koughnett1,3,4 Received: 7 January 2020 / Accepted: 10 March 2020 © Springer Nature Switzerland AG 2020
Abstract Background Prescription of opioid medication after ambulatory anorectal surgery may be excessive and lead to opioid misuse. The purpose of this study was to evaluate the efficacy of a multi-modality opioid-sparing approach to control postoperative pain and reduce opioid prescriptions after outpatient anorectal surgery. Methods A prospective non-inferiority pre- and post-intervention study was completed at three academic hospitals. Patients included were 18–75 years of age who had outpatient anorectal surgeries. The Standardization of Outpatient Procedure (STOP) Narcotics intervention was implemented, which is a multi-pronged analgesia bundle integrating patient education, health care provider education, and intra-/postoperative analgesia focused on multi-modal pain control strategies and opioidreduced prescriptions. The primary outcome was patient-reported average pain in the first 7 postoperative days. Secondary outcomes included patient-reported quality of pain management, medication utilization, prescription refills and medication disposal. Results Ninety-three patients had outpatient anorectal surgery (42 pre-intervention and 51 post-intervention). No difference was seen in average postoperative pain in the pre- vs. post-intervention groups (2.8 vs. 2.6 on an 11-point scale, p = 0.33) or patient-reported quality of pain control (good/very good in 57% vs. 63%, p = 0.58). The median oral morphine equivalents (OME) prescribed was significantly less [112.5 (IQR 50–150) pre-intervention vs. 50 (IQR 50–50) post-intervention, p
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