Utilization and evolving prescribing practice of opioid and non-opioid analgesics in patients undergoing lymphadenectomy for cutaneous malignancy
Russell G. Witt
Department of Surgical Oncology, M.D. Anderson Cancer Center, University of Texas, Houston, Texas
Search for more papers by this authorBrandon Cope
Department of Surgical Oncology, M.D. Anderson Cancer Center, University of Texas, Houston, Texas
Search for more papers by this authorYi-Ju Chiang
Department of Surgical Oncology, M.D. Anderson Cancer Center, University of Texas, Houston, Texas
Search for more papers by this authorTimothy Newhook
Department of Surgical Oncology, M.D. Anderson Cancer Center, University of Texas, Houston, Texas
Search for more papers by this authorHeather Lillemoe
Department of Surgical Oncology, M.D. Anderson Cancer Center, University of Texas, Houston, Texas
Search for more papers by this authorChing-Wei D. Tzeng
Department of Surgical Oncology, M.D. Anderson Cancer Center, University of Texas, Houston, Texas
Search for more papers by this authorIris B. Chen
Department of Surgical Oncology, M.D. Anderson Cancer Center, University of Texas, Houston, Texas
Search for more papers by this authorSarah B. Fisher
Department of Surgical Oncology, M.D. Anderson Cancer Center, University of Texas, Houston, Texas
Search for more papers by this authorAnthony Lucci
Department of Surgical Oncology, M.D. Anderson Cancer Center, University of Texas, Houston, Texas
Search for more papers by this authorJennifer A. Wargo
Department of Surgical Oncology, M.D. Anderson Cancer Center, University of Texas, Houston, Texas
Search for more papers by this authorJeffrey E. Lee
Department of Surgical Oncology, M.D. Anderson Cancer Center, University of Texas, Houston, Texas
Search for more papers by this authorMerrick I. Ross
Department of Surgical Oncology, M.D. Anderson Cancer Center, University of Texas, Houston, Texas
Search for more papers by this authorJeffrey E. Gershenwald
Department of Surgical Oncology, M.D. Anderson Cancer Center, University of Texas, Houston, Texas
Search for more papers by this authorJustine Robinson
Department of Surgical Oncology, M.D. Anderson Cancer Center, University of Texas, Houston, Texas
Search for more papers by this authorCorresponding Author
Emily Z. Keung
Department of Surgical Oncology, M.D. Anderson Cancer Center, University of Texas, Houston, Texas
Correspondence Emily Z. Keung, MD, AM, Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Unit 1484, Houston, TX 77030, USA.
Email: [email protected]
Search for more papers by this authorRussell G. Witt
Department of Surgical Oncology, M.D. Anderson Cancer Center, University of Texas, Houston, Texas
Search for more papers by this authorBrandon Cope
Department of Surgical Oncology, M.D. Anderson Cancer Center, University of Texas, Houston, Texas
Search for more papers by this authorYi-Ju Chiang
Department of Surgical Oncology, M.D. Anderson Cancer Center, University of Texas, Houston, Texas
Search for more papers by this authorTimothy Newhook
Department of Surgical Oncology, M.D. Anderson Cancer Center, University of Texas, Houston, Texas
Search for more papers by this authorHeather Lillemoe
Department of Surgical Oncology, M.D. Anderson Cancer Center, University of Texas, Houston, Texas
Search for more papers by this authorChing-Wei D. Tzeng
Department of Surgical Oncology, M.D. Anderson Cancer Center, University of Texas, Houston, Texas
Search for more papers by this authorIris B. Chen
Department of Surgical Oncology, M.D. Anderson Cancer Center, University of Texas, Houston, Texas
Search for more papers by this authorSarah B. Fisher
Department of Surgical Oncology, M.D. Anderson Cancer Center, University of Texas, Houston, Texas
Search for more papers by this authorAnthony Lucci
Department of Surgical Oncology, M.D. Anderson Cancer Center, University of Texas, Houston, Texas
Search for more papers by this authorJennifer A. Wargo
Department of Surgical Oncology, M.D. Anderson Cancer Center, University of Texas, Houston, Texas
Search for more papers by this authorJeffrey E. Lee
Department of Surgical Oncology, M.D. Anderson Cancer Center, University of Texas, Houston, Texas
Search for more papers by this authorMerrick I. Ross
Department of Surgical Oncology, M.D. Anderson Cancer Center, University of Texas, Houston, Texas
Search for more papers by this authorJeffrey E. Gershenwald
Department of Surgical Oncology, M.D. Anderson Cancer Center, University of Texas, Houston, Texas
Search for more papers by this authorJustine Robinson
Department of Surgical Oncology, M.D. Anderson Cancer Center, University of Texas, Houston, Texas
Search for more papers by this authorCorresponding Author
Emily Z. Keung
Department of Surgical Oncology, M.D. Anderson Cancer Center, University of Texas, Houston, Texas
Correspondence Emily Z. Keung, MD, AM, Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Unit 1484, Houston, TX 77030, USA.
Email: [email protected]
Search for more papers by this authorAbstract
Background and Objectives
Opioids are commonly prescribed following surgery and can lead to persistent opioid use. We assessed changes in prescribing practices following an opioid education initiative for patients undergoing lymphadenectomy for cutaneous malignancy.
Methods
A single-institution retrospective study of all eligible patients (3/2016–3/2020) was performed.
Results
Indications for lymphadenectomy in 328 patients were metastatic melanoma (84%), squamous cell carcinoma (10%), and Merkel cell carcinoma (5%). At discharge, non-opioid analgesics were increasingly utilized over the 4-year study period, with dramatic increases after education initiatives (32%, 42%, 59%, and 79% of pts, respectively each year; p < 0.001). Median oral morphine equivalents (OMEs) prescribed also decreased dramatically starting in year 3 (250, 238, 150, and 100 mg, respectively; p < 0.001). Patients discharged with 200 mg OMEs were less likely to also be discharged with non-opioid analgesics (40% vs. 64%. respectively, p < 0.001).
Conclusions
Analgesic prescribing practices following lymphadenectomy for cutaneous malignancy improved significantly over a 4-year period, with use of non-opioids more than doubling and a 60% reduction in median OME. Opportunities exist to further increase non-opioid use and decrease opioid dissemination after lymphadenectomy for cutaneous malignancy.
Open Research
DATA AVAILABILITY STATEMENT
The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.
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