Abstract No. 238 Influence of a Change in Post-procedure Discharge Opioid Prescription Protocol in cTACE Patients

To evaluate the impact of a change in discharge opioid prescription protocol after conventional transarterial chemoembolization (cTACE). An institutional review board–approved retrospective review of patients undergoing cTACE between 5/2021 and 5/2023 was performed. Patients were divided into pre-protocol and post-protocol groups. The protocol change in 5/2022 was a transition from prescribing 3 days of opioids for all cTACE patients to providing an opioid prescription only if a subcapsular tumor was treated or prior need for opioids after liver-directed therapy was documented. Patients were excluded for non-hepatic cTACE, incompletely documented pain/opioid prescriptions, or follow-up less than 30d. Patient demographics, relevant oncologic history, intra-procedural details, concurrent procedures, pain scores, complications, and opioid prescriptions for 30d post-procedure were recorded. Chi-squared, Fischer's exact, Mann-Whitney U, and linear regression analyses were performed to evaluate factors impacting post-discharge opioid use. 102 patients undergoing first cTACE were reviewed (pre-protocol, n=68 and post-protocol, n=34). The majority of procedures were for hepatocellular carcinoma (HCC) (n=75, 74%). The protocol change resulted in significantly fewer post-procedure opioid prescriptions (17/34 (50%) vs 56/68 (82.4%), p< 0.001) and median morphine milligram equivalents (MME) (90 (range: 0-480) vs 15 (0-195), p =0.003). There was no significant difference between groups in reported post-procedure pain after discharge (35/68 (51.5%) vs 19/34 (55.9%), p=0.67). The change in protocol did not delay opioid prescription for pain after discharge. Opioid prescriptions by interventional radiology were significantly lower in patients with concurrent opioid prescriptions from other providers (B=-39.6, p=0.02). A revised discharge opioid prescribing practice for cTACE patients results in significantly fewer opioid prescriptions and total MME by interventional radiology without increased rates of reported post-procedure pain or delayed opioid prescriptions for pain.