Young DHMC doctors see path to fewer opioid prescriptions
Can training targeted to surgeons reduce the over-prescription of addictive opiates? New research by young surgical investigators at Dartmouth-Hitchcock Medical Center (D-H) indicates that it’s possible to use training to reduce opioid prescribing by more than half and still meet patients’ opioid requirements following general surgery.
The research team, led by D-H surgery resident Maureen Hill, MD, analyzed opioid prescription and use for common outpatient operations, such as partial mastectomy and hernia repair. The team then developed guidelines for opioid prescribing, including encouraging patients to use over-the-counter medications, such as Advil and Tylenol, before using opioids. Utilization of the guidelines by surgeons participating in the study resulted in half the number of pills being prescribed, while satisfying 80% of patients’ opioid requirements.
Hill presented her team’s findings at the fifth annual STARS (Surgical Trainees Advancing Research Symposium) held April 13-14 at D-H. The symposium promotes interest in surgical health services research among early-career surgeons and medical students through a competition in which prizes are awarded for original research that involves surgical practices and/or treatment outcomes.
“Using research to address pressing questions in surgery—from how to improve discharge timing of patients to how to use telemedicine to improve patient satisfaction—is a key aspect of surgical training,” said symposium co-director Philip Goodney, MD.
STARS, which began as a surgical grand rounds event in 2013, was expanded to a two-day event this year with the addition of an evening event, “Dinner with the Stars,” which featured three-minute ‘quickshot’ presentations from surgical trainees and a keynote address. Invited guest, Karl Bilimoria, MD, MS, a surgical oncologist and a health services and quality improvement researcher, and the John B. Murphy Professor of Surgery at Northwestern University's Feinberg School of Medicine, delivered the keynote, “Informing Policy with Evidence: The FIRST Resident Duty Hour Trial.” Bilimoria discussed a pivotal study that he co-authored about the effects of loosening restrictions on surgical residents’ work hours on improving physician welfare and satisfaction.
The highest scoring abstracts – from those submitted and selected for presentation in advance of the event – were presented the following morning. They were judged by a panel of D-H surgeons that included Sandra Wong, MD, MS; symposium co-director Kari Rosenkranz, MD; Alexander Iribarne, MD, MS; Joga Ivatury, MD, MHA; Florian Schroeck, MD, MS; Philip Goodney, MD, MS; Joseph Philips, MD and visiting faculty, Karl Bilimoria, MD, MS. First, second- and third-place awards were given to the top presenters:
First place ($500): Maureen Hill, MD, MS, “An Educational Intervention Decreases Opioid Prescribing after General Surgical Operations”
Second place ($250): Jesse Columbo, MD, VA Outcomes Group Fellow and Dartmouth Institute MS student, “Long-Term Mortality After Carotid Revascularization: A Novel Instrumental Variable Method for Valid Inference”
Third place ($100): John Fallon, MD, MS, “The incidence and consequence of patient prosthesis mismatch after surgical aortic valve replacement”
Young Investigator ($100): Karissa Tauber, Geisel School of Medicine, “Medicare-Linked Registries Can Accurately Capture True Clinical Events”