To evaluate the impact of CYP2D6-guided opioid prescribing on postoperative pain and opioid use compared to usual care.
Key Findings:
Genotype-guided prescribing increased concordance between opioid selection and metabolic phenotype (64% vs 27%).
Hydrocodone prescribing decreased in the genotype-guided group (24% vs 58%), while hydromorphone use increased (39% vs 3%).
Postoperative pain outcomes were similar between groups, with mean Silverman scores of 1.4 and -1.4 respectively, and nonopioid strategies were frequently used.
Interpretation:
CYP2D6-guided opioid prescribing altered prescribing patterns but did not improve postoperative pain control or reduce opioid use, raising questions about its clinical utility.
Limitations:
Prescribers' autonomy may have led to incomplete adherence to genotype-based recommendations, and high variability in the Silverman score may have obscured differences between groups, with missing data affecting about 11% of the actionable population.
Conclusion:
The study concluded that CYP2D6-guided opioid therapy does not enhance pain management in the context of multimodal postoperative care, highlighting the need for further research.
