Surgery Open Science (Jul 2022)
A prospective feasibility study evaluating the 5x-multiplier to standardize discharge prescriptions in cancer surgery patients
- Timothy P. DiPeri, MD,
- Timothy E. Newhook, MD,
- Ryan W. Day, MD,
- Yi-Ju Chiang, MSPH,
- Whitney L. Dewhurst, MS, AGNP-C,
- Elsa M. Arvide, MS, PA-C,
- Morgan L. Bruno, MS, ACNP-BC,
- Christopher P. Scally, MD, MS,
- Christina L. Roland, MD, MS,
- Matthew H.G. Katz, MD,
- Jean-Nicolas Vauthey, MD,
- George J. Chang, MD, MS,
- Brian D. Badgwell, MD, MS,
- Nancy D. Perrier, MD,
- Elizabeth G. Grubbs, MD,
- Jeffrey E. Lee, MD,
- Ching-Wei D. Tzeng, MD,
- Brian K. Bednarski, MD,
- Iris B. Chen, MS, APRN,
- Ryan J. Comeaux, MS, PA-C,
- Dana M. Cox, MPAS, PA-C,
- Barry W. Feig, MD,
- Sarah B. Fisher, MD,
- Keith F. Fournier, MD,
- Semhar J. Ghebremichael, MD,
- Heather M. Gibson, MS, PA-C,
- Nicole C. Gourmelon, MS, PA-C,
- Paul H. Graham, MD,
- Shannon Hancher, MD,
- Kelly K. Hunt, MD,
- Naruhiko Ikoma, MD, MPH,
- Shanae L. Ivey MPAS, PA-C,
- Emily Z. Keung, MD,
- Celia R. Ledet, MD,
- Angela R. Limmer, MS, PA-C,
- Paul F. Mansfield, MD,
- Lauren K. Mayon, MS, PA-C,
- Craig A. Messick, MD,
- Keyuri U. Popat, MD,
- Nikita F. Rajkot MPAS, PA-C,
- Justine L. Robinson MPAS, PA-C,
- Kristen A. Robinson MPAS, PA-C,
- Miguel A. Rodriguez-Bigas, MD,
- David A. Santos, MD, MS,
- John M. Skibber, MD,
- B. Bryce Speer, DO,
- Jose Soliz, MD,
- Matthew M. Tillman, MD,
- Keila E. Torres, MD,
- Antoinette van Meter, MD,
- Marla E. Weldon, MS, PA-C,
- Uduak Ursula Williams, MD,
- Y. Nancy You, MD, MHSc
Affiliations
- Timothy P. DiPeri, MD
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Timothy E. Newhook, MD
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Ryan W. Day, MD
- Department of Surgery, Division of Transplant Surgery, University of California San Francisco, San Francisco, CA
- Yi-Ju Chiang, MSPH
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Whitney L. Dewhurst, MS, AGNP-C
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Elsa M. Arvide, MS, PA-C
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Morgan L. Bruno, MS, ACNP-BC
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Christopher P. Scally, MD, MS
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Christina L. Roland, MD, MS
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Matthew H.G. Katz, MD
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Jean-Nicolas Vauthey, MD
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- George J. Chang, MD, MS
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Brian D. Badgwell, MD, MS
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Nancy D. Perrier, MD
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Elizabeth G. Grubbs, MD
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Jeffrey E. Lee, MD
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Ching-Wei D. Tzeng, MD
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; Corresponding author at: University of Texas MD Anderson Cancer Center, Department of Surgical Oncology, 1400 Pressler Dr, Unit 1484, Houston, TX 77030. Tel.: (713) 792-0386; fax: (713) 745-1921.
- Brian K. Bednarski, MD
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Iris B. Chen, MS, APRN
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Ryan J. Comeaux, MS, PA-C
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Dana M. Cox, MPAS, PA-C
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Barry W. Feig, MD
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Sarah B. Fisher, MD
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Keith F. Fournier, MD
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Semhar J. Ghebremichael, MD
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Heather M. Gibson, MS, PA-C
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Nicole C. Gourmelon, MS, PA-C
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Paul H. Graham, MD
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Shannon Hancher, MD
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Kelly K. Hunt, MD
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Naruhiko Ikoma, MD, MPH
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Shanae L. Ivey MPAS, PA-C
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Emily Z. Keung, MD
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Celia R. Ledet, MD
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Angela R. Limmer, MS, PA-C
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Paul F. Mansfield, MD
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Lauren K. Mayon, MS, PA-C
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Craig A. Messick, MD
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Keyuri U. Popat, MD
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Nikita F. Rajkot MPAS, PA-C
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Justine L. Robinson MPAS, PA-C
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Kristen A. Robinson MPAS, PA-C
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Miguel A. Rodriguez-Bigas, MD
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- David A. Santos, MD, MS
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- John M. Skibber, MD
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- B. Bryce Speer, DO
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Jose Soliz, MD
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Matthew M. Tillman, MD
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Keila E. Torres, MD
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Antoinette van Meter, MD
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Marla E. Weldon, MS, PA-C
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Uduak Ursula Williams, MD
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Y. Nancy You, MD, MHSc
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Journal volume & issue
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Vol. 9
pp. 51 – 57
Abstract
Background: We designed a prospective feasibility study to assess the 5x-multiplier (5x) calculation (eg, 3 pills in last 24 hours × 5 = 15) to standardize discharge opioid prescriptions compared to usual care. Methods: Faculty-based surgical teams volunteered for either 5x or usual care arms. Patients undergoing inpatient (≥48 hours) surgery and discharged by surgical teams were included. The primary end point was discharge oral morphine equivalents. Secondary end points were opioid-free discharges and 30-day refill rates. Results: Median last 24-hour oral morphine equivalents was similar between arms (7.5 mg 5x vs 10 mg usual care, P = .830). Median discharge oral morphine equivalents were less in the 5x arm (50 mg 5x vs 75 mg usual care, P < .001). Opioid-free discharges included 33.5% 5x vs 18.0% usual care arm patients (P < .001). Thirty-day refill rates were similar (15.3% 5x vs 16.5% usual care, P = .742). Conclusion: The 5x-multiplier was associated with reduced opioid prescriptions without increased refills and can be feasibly implemented across a diverse surgical practice.
