From Evidence to Practice Change: Innovations in Postoperative Practice to Reduce Modified-release Opioid Prescribing for Acute Pain After Surgery

This presentation will demonstrate how a comprehensive research program breaks boundaries by translating empirical evidence into practice change across national and international policies. A collection of research including literature reviews, multi-centre observational studies, and qualitative studies will be presented to demonstrate their impact on policy and subsequent strategies to impact clinical practice.  

First, a systematic review and meta-analysis of eight studies evaluated safety and efficacy. The meta-analysis demonstrated modified-release opioids increase adverse events (odds ratio 2.76) and yield worse pain outcomes (standardised mean difference 0.2).  

Second, an Australian multicentre propensity score-matched cohort study of 694 patients (347 per group) compared modified-release versus immediate-release opioids. Statistical analyses utilized multivariable logistic regression for matching, Fisher's exact test for adverse events, and Mann-Whitney U-tests for length of stay. The matched cohort study confirmed a higher adverse event rate (20.5% vs 12.7%) and prolonged median hospital stays (8 vs 5 days). 

Third, a scoping review of 24 articles mapped factors influencing modified-release prescribing. Fourth, qualitative interviews with 20 to 30 clinicians were conducted to explore prescribing barriers using inductive thematic analysis. Finally, a cluster randomised controlled trial across eight private hospitals (target n=106) will evaluate the Resources for Opioid Stewardship Implementation (ROSI) bundle, using a generalised linear mixed model. 

The presentation will conclude by illustrating how these foundational findings directly informed national policy by the Australian and New Zealand College of Anaesthetists and a global position statement under development by the International Association for the Study of Pain Opioid Taskforce. Finally, attendees will learn how the ROSI bundle has been used to translate these findings to implement practice change in Australian private hospitals. 

After this session, participants will be able to: 

• Evaluate the safety and efficacy of modified-release opioids compared with immediate-release opioids for acute postoperative pain.
• Identify the surgical, patient, and health system factors influencing clinicians' decisions to prescribe modified-release opioids. 
• Outline evidence-based strategies and stewardship bundles to reduce extended-release opioid prescribing in private and public hospital settings.