Trial reportAnnals of surgery2026
5x-Multiplier Versus 3-Tier Model: A Pragmatic Randomized Clinical Trial for Discharge Opioid Prescriptions After Intra-Abdominal Cancer Surgery.
Trial report in Annals of surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Authors and funding
14 authors.
Funding
Abstract
backgroundStandardized prescribing models can reduce discharge opioid prescriptions and excess pill volumes, mitigating potential opioid dependence and diversion after abdominal operations. This study's objective was to determine which of 2 validated discharge prescribing models resulted in fewer opioids prescribed and consumed after major abdominal surgery.
methodsThis was a pragmatic single-center, phase II randomized clinical trial comparing 2 discharge opioid prescribing models: linear 5x-multiplier algorithm [last 24 h oral morphine equivalents (OME) times 5] versus capped 3-tier model (5/15/30 pills depending on 0/1-29/≥30 mg OME in last 24 h). Adults undergoing open abdominal cancer resections by 25 surgeons (5 specialties) were included. A nonopioid analgesic bundle was used perioperatively and at discharge. Coprimary endpoints were discharge opioid volume and 14-day post-discharge consumption. Secondary endpoints included patient satisfaction and symptom inventory. The power (80%) calculation was performed using the 2-sample t -test to detect a mean difference in OME with 0.05 significance (0.025 per co-primary outcomes).
resultsFrom April to December 2024, 150 patients (52% female; median age 63) were randomized: 73 to 5x-multiplier; 77 to 3-tier model. Operations included hepatectomy (32%), pancreatectomy (29%), nephrectomy (13%), thoracoabdominal sarcoma resection (15%), and ovarian cytoreduction (11%). Median discharge OME was 25 mg (5x-multiplier) versus 75 mg (3-tier, P <0.001), with 44% of 5x-multiplier patients discharged opioid-free (1% in 3-tier). Median post-discharge 14-day opioid consumption was 0 mg (5x-multiplier) versus 10 mg (3-tier, P =0.496). Refill rates were 24% (5x-multiplier) versus 18% (3-tier, P =0.426), consistent with historical rates, with no differences in satisfaction or symptom inventory scores.
conclusionThe 5x-multiplier algorithm resulted in fewer prescribed discharge opioids with similar 14-day consumption, refill rates, and satisfaction, compared with a 3-tier model after intra-abdominal cancer surgery.
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