N/A Completed N=640 Randomized Double-blind Health Services Research

Postoperative Nudges to Reduce Opioid Prescribing

Opioid Prescribing

Source: ClinicalTrials.gov NCT05070338 ↗

Enrolled (actual)

640

Serious AEs

7.1%

Results posted

Apr 2025

Primary outcomePrimary: Proportion of Discharges With Opioid Prescriptions Above Prescribing Guidelines — 0.254; 0.275; 0.368 Proportion of discharges

Summary

This study tests the effectiveness of two email-based behavioral nudges, one based on peer behavior and one based on best practice guidelines, in reducing excessive opioid prescriptions after surgery. It will be conducted in three surgical specialties (general surgery, orthopedic surgery, and obstetric/gynecological surgery) at 19 hospitals within one healthcare system. These specialties will each be randomized to a control group or one of two nudge groups. Each month for one year, surgeons in the nudge groups will receive emails comparing their opioid prescribing either to their peers' prescribing or to prescribing guidelines. Both types of email-based nudges are expected to reduce opioid prescribing after surgery.

Outcome Measures

Outcome	Result	p-value
PRIMARY Proportion of Discharges With Opioid Prescriptions Above Prescribing Guidelines	0.254; 0.275; 0.368	—
SECONDARY Morphine Milligram Equivalents (MMEs) Prescribed at Discharge	78.7; 58.6; 67.6	—
SECONDARY Days' Supply of Opioids Prescribed at Discharge	—	—
SECONDARY Proportion of Discharges Where Any Opioid Was Prescribed	0.484; 0.476; 0.518	—
SECONDARY Proportion of Patients on Opioids for Greater Than 3 Months Post-discharge	0.123; 0.099; 0.102	—
SECONDARY Number of 30-day All-cause Emergency Department Visits	0.062; 0.057; 0.062	—
SECONDARY Number of 30-day All-cause Hospitalizations	0.023; 0.029; 0.023	—
SECONDARY Proportion of Discharge Opioid Prescriptions Above Prescribing Guidelines in the Year After the Intervention Ends	0.253; 0.250; 0.363	—

Eligibility Criteria

The nudges that a surgeon in either intervention arm will receive are based on that surgeon's eligible discharge opioid prescriptions in the previous month. Eligible prescriptions meet all of the following criteria:

the patient is at least 18 years old at the date of surgery
the patient is discharged to their home
the surgical procedure has an applicable post-operative opioid prescribing guideline
the surgical procedure is the only surgical procedure performed during the patient's hospital stay
the prescription is for an opioid taken orally (tablets, capsules, or liquid solution)

To avoid contamination between the intervention arms, surgeons who operate across multiple surgical specialties (defined as surgeons who performed less than 90% of their total procedures in one specialty between June 2020 and May 2021) will not be eligible.

View full record on ClinicalTrials.gov →

Data sourced from ClinicalTrials.gov (NCT05070338). Outcome figures and adverse-event rates are extracted automatically from the registry's posted results and are provided for clinician reference, not as a substitute for the primary publication. Informational only — not medical advice.