Wide Variation and Overprescription of Opioids After Elective Surgery

• Published in: Annals of surgery Vol. 266; no. 4; pp. 564 - 573
• Main Authors: Thiels, Cornelius A, Anderson, Stephanie S, Ubl, Daniel S, Hanson, Kristine T, Bergquist, Whitney J, Gray, Richard J, Gazelka, Halena M, Cima, Robert R, Habermann, Elizabeth B
• Format: Journal Article
• Language: English
• Published: United States Copyright Wolters Kluwer Health, Inc. All rights reserved 01-10-2017
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Analgesics, Opioid - therapeutic use; Arizona; Elective Surgical Procedures - adverse effects; Female; Florida; Humans; Inappropriate Prescribing - statistics & numerical data; Male; Middle Aged; Minnesota; Morphine - therapeutic use; Pain, Postoperative - prevention & control; Postoperative Care; Practice Patterns, Physicians; Young Adult
• ISSN: 0003-4932; 1528-1140
• DOI: 10.1097/SLA.0000000000002365

OBJECTIVE:We aimed to identify opioid prescribing practices across surgical specialties and institutions.
BACKGROUND:In an effort to minimize the contribution of prescription narcotics to the nationwide opioid epidemic, reductions in postoperative opioid prescribing have been proposed. It has been suggested that a maximum of 7 days, or 200 mg oral morphine equivalents (OME), should be prescribed at discharge in opioid-naïve patients.
METHODS:Adults undergoing 25 common elective procedures from 2013 to 2015 were identified from American College of Surgeons National Surgical Quality Improvement Program data from 3 academic centers in Minnesota, Arizona, and Florida. Opioids prescribed at discharge were abstracted from pharmacy data and converted into OME. Wilcoxon Rank-Sum and Kruskal-Wallis tests assessed variations.
RESULTS:Of 7651 patients, 93.9% received opioid prescriptions at discharge. Of 7181 patients who received opioid prescriptions, a median of 375 OME (interquartile range 225–750) were prescribed. Median OME varied by sex (375 men vs 390 women, P = 0.002) and increased with age (375 age 18–39 to 425 age 80+, P < 0.001). Patients with obesity and patients with non-cancer diagnoses received more opioids (both P < 0.001). Subset analysis of the 5756 (75.2%) opioid-naïve patients showed the majority received >200 OME (80.9%). Significant variations in opioid prescribing practices were seen within each procedure and between the 3 medical centers.
CONCLUSIONS:The majority of patients were overprescribed opioids. Significant prescribing variation exists that was not explained by patient factors. These data will guide practices to optimize opioid prescribing after surgery.