Patient-Based Decision-Making for Opioid Prescriptions after Ambulatory Breast Operation: A Randomized Clinical Trial.
Serena Y Lofftus, Danielle S Graham, Julie Le et al.
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In 30 seconds
This single-centre randomized clinical trial compared patient opt-in opioid prescribing with routine prescribing in 107 adults undergoing ambulatory breast surgery. In the opt-in group, patients received opioids only if they requested them after education. Prescription rates were 35% with opt-in versus 100% with routine prescribing, an absolute reduction of 65%. Peak postoperative pain and quality-of-life scores did not differ between groups. The findings suggest that an opt-in approach can reduce opioid prescribing and excess medication without worsening these measured outcomes in this population.
Key findings
- Opioid prescription rates were 35% in the opt-in group versus 100% in controls, an absolute reduction of 65%.
- Median pills prescribed were 0 (IQR 0 to 5) with opt-in versus 6 (IQR 5 to 7) with routine prescribing (p < 0.0001).
- Peak pain scores and quality-of-life scores did not differ between groups.
- Pain scores independently predicted opioid use (odds ratio 2.14, 95% CI 1.41 to 3.26; p = 0.00037).
Why it matters
Routine postoperative opioid prescribing can leave patients with unused medication, which may contribute to misuse and diversion. This trial indicates that, after ambulatory breast surgery, making opioid prescriptions contingent on patient request can substantially reduce prescribing while maintaining similar measured pain and quality-of-life outcomes. It supports considering patient preferences as part of postoperative analgesia planning.
What to keep in mind
The trial was conducted at a single tertiary centre and included 107 adults undergoing ambulatory breast surgery, limiting the extent to which findings can be generalized to other settings or procedures.