{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T02:02:06Z","timestamp":1789783326467,"version":"4.0.1"},"reference-count":41,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Standardized prescribing models can reduce discharge opioid prescriptions and excess pill volumes, mitigating potential opioid dependence and diversion after abdominal operations. This study\u2019s objective was to determine which of 2 validated discharge prescribing models resulted in fewer opioids prescribed and consumed after major abdominal surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      This was a pragmatic single-center, phase II randomized clinical trial comparing 2 discharge opioid prescribing models: linear 5x-multiplier algorithm [last 24\u00a0h oral morphine equivalents (OME) times 5] versus capped 3-tier model (5\/15\/30 pills depending on 0\/1\u201329\/\u226530\u00a0mg OME in last 24\u00a0h). 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\n                      <jats:italic toggle=\"yes\">t<\/jats:italic>\n                      -test to detect a mean difference in OME with 0.05 significance (0.025 per co-primary outcomes).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      From 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\u00a0mg (5x-multiplier) versus 75\u00a0mg (3-tier,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;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\u00a0mg (3-tier,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.496). Refill rates were 24% (5x-multiplier) versus 18% (3-tier,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.426), consistent with historical rates, with no differences in satisfaction or symptom inventory scores.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>The 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1097\/sla.0000000000007115","type":"journal-article","created":{"date-parts":[[2026,6,20]],"date-time":"2026-06-20T09:00:15Z","timestamp":1781946015000},"page":"647-657","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["5x-Multiplier Versus 3-Tier Model"],"prefix":"10.1097","volume":"284","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1424-6004","authenticated-orcid":false,"given":"Brittany C.","family":"Fields","sequence":"first","affiliation":[{"name":"Department of Surgical Oncology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6663-459X","authenticated-orcid":false,"given":"Timothy E.","family":"Newhook","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8732-7764","authenticated-orcid":false,"given":"Heather A.","family":"Lillemoe","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0216-1276","authenticated-orcid":false,"given":"Anneliese N.","family":"Hierl","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9600-7837","authenticated-orcid":false,"given":"Innocent","family":"Rukundo","sequence":"additional","affiliation":[{"name":"Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7697-9591","authenticated-orcid":false,"given":"Jose A.","family":"Karam","sequence":"additional","affiliation":[{"name":"Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1638-1445","authenticated-orcid":false,"given":"Surena F.","family":"Matin","sequence":"additional","affiliation":[{"name":"Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2687-7463","authenticated-orcid":false,"given":"Larissa A.","family":"Meyer","sequence":"additional","affiliation":[{"name":"Department of Gynecologic Oncology & Reproductive Medicine, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8058-8435","authenticated-orcid":false,"given":"Zhouxuan","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Division of Discovery Science, The University of Texas MD Anderson Cancer Center, Houston, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Qiao","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Division of Discovery Science, The University of Texas MD Anderson Cancer Center, Houston, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4921-5427","authenticated-orcid":false,"given":"Jean-Nicolas","family":"Vauthey","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3870-6968","authenticated-orcid":false,"given":"Matthew H. 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