Table 1.

Summary of studies included in final review

Author	Journal	Year	Study design	Intervention	Surgery	Sample	Outcomes	Level of evidence
Cui et al. [1]	J Clin Nurs	2018	Prospective cohort study	Pain management protocol for orthopedic nurses	Joint replacement and spinal fusion	31 nurses, 148 patients	After the intervention 66.2% of patients received opioid & non-opioid analgesics (38.8% pre-intervention). Nursing pain management knowledge increased	II
Dwyer et al.	J Hand Surg	2018	Prospective cohort study	Prescribing guidelines, patient handouts	Carpal tunnel release (CTR), volar locked plating of radius (VLP)	145	Average prescription size decreased from 22 to 10 pills (CTR) and 39 to 25 pills (VLP) (p < 0.05 for both). Satisfaction rates were high in both cohorts (CTR, 96%; VLP, 88%)	II
Earp et al. [3]	J Bone Jt Surg Am	2018	Retrospective cohort study	Prescribing guidelines	Hand surgery	518	Mean prescription amounts were significantly reduced from 97.8–176.0%. After implementation, only 16.4% of patients were prescribed an amount above the protocol	III
Egbert et al. [4]	NEJM	1964	Prospective cohort study	Counseling by anesthesiologists	Any	97	Mostly of historical interest. Opioid consumption reduced by half	III
Hill et al. [9]	Ann Surg	2018	Retrospective cohort study	Prescribing guidelines	Partial mastectomy with or without lymph node biopsy, laparoscopic cholecystectomy, laparoscopic/open inguinal hernia repair	915	224 patients in post-intervention cohort, decreases in total number of opioids prescribed ranging from 43.0–74.3%. Refill rate was unchanged	III
Holman et al. [10]	J Orthop Trauma	2014	Retrospective cohort study	Physician counseling on pain management expectations	Trauma or fracture fixation	613	73% of patients in the intervention group ceased opioid use by 6 weeks (vs. 64% of the controls, p = 0.012), no difference in rates of cessation at 12 weeks or greater	III
Howard et al. [11]	J Am Coll Surg	2018	Retrospective cohort study	Prescribing guidelines	Laparoscopic cholecystectomy	1158	Significant reduction in opioid prescription sizes for laparoscopic appendectomy, thyroidectomy, and inguinal hernia repair	III
Howard et al. [12]	JAMA Surg	2018	Retrospective cohort study	Prescribing guidelines	Laparoscopic cholecystectomy	370	Median OME prescription reduced from 250 mg to 75 mg (p < 0.001) with a comparable refill rate (2.5% pre vs. 4.1% post, p < 0.40)	III
Mohamadi et al. [16]	J Bone Jt Surg Am	2018	Meta-analysis of retrospective cohort studies	N/A	N/A	1,969,953	Factors with the strongest associations with prolonged opioid use included prior opioid use (OR 11.04, 95% CI 9.39–12.97); history of back pain (OR 2.1, 95% CI 2.00–2.20); longer hospital stay (OR 2.03, 95% CI 1.03–4.02); depression (OR 1.62, 95% CI 1.49–1.77)	III
Nooromid et al. [19]	Am J Surg	2017	Prospective cohort study	Educational program on opioid prescribing for surgical interns	Any	30	Median MME prescribed per procedure was unchanged by program, though 73% of the interns stated they would prescribe fewer opioids	IV
Stanek et al. [27]	J Hand Surg	2015	Retrospective cohort study	Prescribing guidelines	First dorsal compartment release, ganglion cyst excision, ORIF MCP fracture, trigger finger release	402	Mean prescription sizes were significantly reduced from 15 to 48%. These changes persisted at 1 year	III
Stepan et al. [28]	J Hand Surg	2018	Retrospective cohort study	Prescribing guidelines	Hand surgery	1348	Mean prescription amount reduced by 52.3%. Variability in prescription sizes decreased for all procedures	III
Syed et al. [30]	J Shoulder Elbow Surg	2018	Randomized controlled trial	Pre-operative patient education	Arthroscopic rotator cuff repair	140	At 6 weeks post-operatively, interventional group consumed fewer opioid pills (avg. 87.2 ± 98.3 vs. 51.2 ± 57.7, p < 0.01) and also had a lower average VAS pain score (3.7 ± 2.4 vs. 2.4 ± 2.0, p = 0.001)	I

OME oral morphine equivalents, MME morphine milligram equivalents, ORIF MCP open reduction and internal fixation metacarpal/phalangeal, VAS visual analog scale