09X—Opioid Stewardship in Surgery: A Collaborative Approach Among 300 Hospitals

Monday, March 28th
10:00am11:30am

About the Session

Due to the epidemic of opioid abuse causing 70% of the 71,000 drug-overdose deaths in the U.S. in 2019, coupled with the fact that about 6% of opioid-naïve general surgery patients and 14% of bariatric patients become chronic opioid users after surgery, the purpose of this national quality improvement project, which was developed at the American College of Surgeons (ACS), was to provide centers with a toolkit to reduce opioid use after bariatric surgery.

 The project, called Bariatric Surgery Targeting Opioid Prescriptions (BSTOP), was approved in May 2019, and all accredited bariatric surgery centers (800+) were invited to participate. The timeline included three phases for data collection including baseline, pilot and implementation, and the project’s data collection closed in March 2021. 

Initially, 324 centers agreed to participate. At closure of the project, 310 centers actively collected data totaling 37,891 cases, and 80% of centers completed >75% of data fields. Eight out of 9 binary measures improved from the baseline audit. Compared to baseline, morphine milliequivalent use (MME) decreased for all phases of care: inpatient 68.2 to 44.2 MME, opioids prescribed at discharge 129.5 to 111.9 MME, opioids used post-discharge 60.3 to 49.3 MME and a total of 1,194 patients returned unused opioids for safe disposal (7.3%).

Despite COVID, participation rates in the project remained high with significant improvements in 8/9 binary fields including increased non-opioid analgesic and TAP block use. Decreases were observed in opioid prescribing and MME use in all phases of care. Excessive discharge opioid prescribing remains a key target for continued education and improvement.

This project has demonstrated that with adequate planning, an approach to QI across 300 hospitals is feasible, cost-effective, and can effectively address a public health concern such as opioid diversion and addiction.  

Learning Objectives:

  • Describe the necessary research, planning and execution steps involved with a national collaborative project involving hundreds of hospitals.
  • Discuss the options and use of non-opioid therapies available to surgical patients.

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Presented By

Anthony (Tony) Petrick, MD, FACS, FASMBS

Chief Quality Officer, Inpatient Services/Professor of Surgery
Geisinger Health System

Kimberly Evans-Labok

Project Manager, Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program
American College of Surgeons