6ER-021 Opioid-sparing strategies for discharge analgesia prescribing in non-complex surgeries – a missed opportunity

Background and Importance Opioids are an integral element of post-operative management for moderate to strong pain. Despite their effectiveness they are associated with a range of adverse effects and excessive opioid prescribing has contributed to a widespread international crisis of addiction and overdose, including across Europe and in Australia. Even minor surgeries can serve as an initial event for opioid-naive patients to become persistent opioid users. In Australia, opioid-related harm and associated deaths have risen along with opioid prescribing. Guidelines recommend paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce the opioid analgesics use. NSAIDs in particular work synergistically with opioids, providing opioid-sparing effects. Usage in the final 24 hours of hospital admission guides decision-making around prescribing of discharge analgesia. Aim and Objectives We retrospectively assessed analgesia use patterns in opioid-naive patients undergoing non-complex surgery (length-of-stay 1–4 days post-operatively). We had a particular focus on intermediary analgesia use (NSAIDs and tramadol) and possible NSAIDs contra-indications to short-term use. Material and Methods Patients undergoing surgery under general surgical teams with a post-operative length-of-stay of 1–4 days were retrospectively identified using case mix codes. Use of opiods, non-steroidal anti-inflammatories, tramadol and paracetamol in the final 24 hours of admission were quantified along with possible contra-indications for use and discharge prescribing. Results Of 1015 patients assessed there were 555 (55.7%) who were eligible for NSAIDs and/or tramadol and not prescribed this as an inpatient option, although 310 (55.9%) of these patients still received opioids. In the final 24h of admission 759 patients with no contra-indication to NSAIDs or tramadol did not receive these medications but 314 (41.4%) still received discharge opioids. 79 (7.8%) patients required no opioid analgesia in the final 24 hours but were still prescribed opioid at discharge. A further 122 (12.0%) were not prescribed inpatient paracetamol 31 (25%) but received discharge opioids. Conclusion and Relevance There is an abundance of missed opportunity for opioid-sparing strategies to be employed in this cohort. These poor prescribing patterns were largely driven by engrained culture and/or junior prescriber unawareness of options. Further work is underway to define post-discharge analgesia use patterns in order to inform development of clinical decision support to address this issue. References and/or Acknowledgements Conflict of Interest No conflict of interest.