HMN 2026: How Team approach, low-cost interventions lead to major reduction in opioid prescriptions after surgery

A novel team approach founded on a culture change among clinicians and doctor-patient communication successfully reduced post-surgical opioid use, a new study led by University of Rochester Medical Center (URMC) researchers shows.

“Our goal was to achieve a 20% reduction in opioid prescription at discharge, but the strategies we deployed actually reduced it by 67%, and they did so without any increase in patient-reported concern about pain,” said endocrine surgeon Jacob Moalem, MD, the study’s lead author. “One surgeon stated that prior to this project, he never would have imagined sending certain patients home without an opioid prescription, but the team now does it routinely.”

The study, published in the Journal of the American College of Surgeons, is the first report of a low-cost, scalable, and self-sustaining opioid stewardship program spanning all perioperative phases.

Opioid overprescriptions after surgery remain extremely common nationwide, even as studies show that most of what’s prescribed goes unused, leaving staggering amounts of medication left over for potential misuse. Evidence also shows that new, persistent opioid use is seen even after limited post-surgical exposure.

Moalem and his co-authors deployed patient- and staff-directed educational materials, electronic medical record modifications and a dashboard that tracked and analyzed opioid prescribing across the Department of Surgery. They followed 6,619 opioid-naïve adult patients undergoing one of 15 elective procedures through URMC’s acute care, colorectal, thoracic, transplant, and surgical oncology divisions.

“The culture change was the secret ingredient here,” said Moalem, professor of Surgery and Medicine at the University of Rochester School of Medicine & Dentistry. “We empowered the care team with all the information they needed to make an informed decision on a prescription that matched the patient’s needs, as opposed to simply defaulting to a standardized quantity of opioids.”

For patients, the message is simple: Some discomfort after surgery is normal and expected, and the goal for postoperative pain management should be to reduce the discomfort to a level that does not interfere with normal activities of daily life. We should not aim to eliminate all discomfort after surgery, Moalem said.

“Most patients generally understand that opioids are not a panacea and that they come with downsides, but patients may also be scared, anxious, and expect that their post-surgical pain will be treated,” he added. “Balancing those factors is where the conversation with your doctor comes in, and where there is an opportunity to set proper expectations and to explore opioid alternatives. When doctors and patients work together on that, we see the best results.”

Other results from the study include:

• The reduction in median discharge opioid prescriptions was achieved across 14 of the 15 procedures studied, with 10 operations reaching a median prescription discharge quantity of zero.
• 70% of the patients were discharged with no opioids whatsoever.
• Patients had 3.4-fold higher odds of being discharged without opioid medications, and a reduction in the likelihood of receiving a refill or a prescription for opioids after discharge.
• Patients discharged with an opioid prescription received an average of eight fewer pills.

Specific interventions implemented by the study authors include:

• Badge tags showing recommended prescription quantities for common operations were distributed to all residents and APPs, with larger versions posted at computer terminals.
• Distribution of prescribing data, benchmarked against prescribing goals that surgeons set for themselves, to division chiefs via monthly dashboards.
• Electronic medical record updates including automatic displays of a patient’s opioid administrations over the 48 hours prior to discharge; a window encouraging the prescription of opioid alternatives; a streamlined opioid prescription panel promoting lower, preferred quantities; and a best-practice advisory panel requiring justification for opioid prescriptions for patients who are being discharged with a prescription for opioids despite not receiving any in the hospital in the prior 48 hours.

A key advantage of the program is its replicability. The interventions are low-cost and easy to implement, and several other URMC surgical departments are already using the toolkit and seeing positive results.

“Opioids remain an important and sometimes-indispensable tool in the management of pain,” Moalem said. “But this project helps us rightsize the prescriptions to patient need, and eliminates a massive amount of leftover, unused medications that could easily be misused.”

Moalem said he and his co-authors will next look at whether the improvements can be sustained over time and the extent to which their suggested interventions work in other departments. A recent presentation by surgery resident Mitchell Breitenbach at the Academic Surgical Congress is a positive sign.

In a follow-up study on patients undergoing laparoscopic cholecystectomy, the department’s baseline prescribing after laparoscopic cholecystectomy was well within national recommendations, but the interventions described above reduced postoperative prescriptions by 48%—amounting to an annual savings of approximately 10,000 pills—with no change in the frequency of patient phone calls for inadequate pain management.

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