Wide variation of opioid prescribing persists despite attempts to quantify number of opioids utilized postoperatively. We aim to prospectively determine number of opioids used after common surgery procedures to guide future prescribing.
Methods
A prospective observational trial was performed of opioids prescribed and used postoperatively. Patients filled out pre- and postoperative surveys, and number of opioids utilized was captured at postoperative visit.
Results
One-hundred-and-thirteen patients met inclusion. Median opioids prescribed exceeded number of opioids taken for all procedures. Median number of opioids taken postoperatively was fewer than 10 for all categories of procedures: simple skin/soft tissue 2 (IQR 1-4), complex skin/soft tissue 1.5 (IQR 0-14), simple laparoscopy 1 (IQR 0-20) and complex laparoscopy 4 (IQR 0-20), laparotomy 0 (IQR 0-26), and open inguinal hernia 2 (IQR 0-2). Nearly 80% of patients had leftover opioids, and 31% planned to keep them. There was little difference between preoperative and postoperative level of satisfaction with a pain control regimen.
Discussion
Postoperatively, patients utilize opioids less frequently than prescribed and often keep leftover pills. Patient pain control satisfaction is unrelated to number of opioids prescribed and taken postoperatively.
ChenLHHedegaardHWarnerM. Drug-poisoning deaths involving opioid analgesics: United States, 1999-2011. NCHS Data Brief. 2014;166:1-8.
2.
MaxwellJC. The pain reliever and heroin epidemic in the United States: Shifting winds in the perfect storm. J Addict Dis. 2015;34:127-140.
3.
ThielsCAAndersonSSUblDS, et al.Wide variation and overprescription of opioids after elective surgery. Ann Surg. 2017;266(4):564-573. doi:10.1097/SLA.0000000000002365
4.
HillMVMcmahonMLStuckeRSBarthRJ. Wide variation and excessive dosage of opioid prescriptions for common general surgical procedures. Ann Surg. 2017;265(4):709-714. doi:10.1097/SLA.0000000000001993
5.
LeeJSHuHMBrummettCM, et al.Postoperative opioid prescribing and the pain scores on hospital consumer assessment of healthcare providers and systems survey. JAMA. 2017;317(19):2013-2015. doi:10.1001/jama.2017.2827
BrummettCMWaljeeJGoeslingJ, et al.New persistent opioid use after minor and major surgery in U.S. adults. JAMA Surg. 2017;152(6):e170504. doi:10.1016/j.physbeh.2017.03.040
8.
SadaAUblDSThielsCA, et al.Optimizing opioid-prescribing practices after parathyroidectomy. J Surg Res. 2020;245:107-114. doi:10.1016/j.jss.2019.07.039
9.
KnightAWHabermannEBUblDSZielinskiMDThielsCA. Opioid utilization in minimally invasive versus open inguinal hernia repair. Surgery. 2019;166(5):752-757. doi:10.1016/j.surg.2019.05.012
10.
ScullyRESchoenfeldAJJiangW, et al.Defining optimal length of opioid pain medication prescription after common surgical procedures. JAMA Surg. 2018;153:37-43. doi:10.1001/jamasurg.2017.3132
11.
HartfordLBVan KoughnettJAMMurphyPB, et al.Standardization of outpatient procedure (STOP) narcotics: A prospective non-inferiority study to reduce opioid use in outpatient general surgical procedures. J Am Coll Surg. 2019;228(1):81-88. doi:10.1016/j.jamcollsurg.2018.09.008
12.
MerrillHMDeanDMMottlaJLNeufeldSKCutticaDJBuchananMM. Opioid consumption following foot and ankle surgery. Foot Ankle Int. 2018;39(6):649-656. doi:10.1177/1071100718757527
13.
OvertonHNHannaMNBruhnWE, et al.Opioid-prescribing guidelines for common surgical procedures: An expert panel consensus. J Am Coll Surg. 2018;227(4):411-418. doi:10.1016/j.jamcollsurg.2018.07.659
14.
EvansCJTrudeauEMertzanisP, et al.Development and validation of the pain treatment satisfaction scale (PTSS): A patient satisfaction questionnaire for use in patients with chronic or acute pain. Pain. 2004;112(3):254-266. doi:10.1016/j.pain.2004.09.005
15.
DineenKKDuboisJM. Between a rock and a hard place: Can physicians prescribe opioids to treat pain adequately while avoiding legal sanction?Am J Law Med. 2016;42(1):7-52.
16.
HallwayAVuJLeeJ, et al.Patient satisfaction and pain control using an opioid-sparing postoperative pathway. J Am Coll Surg. 2019;229(3):316-322. doi:10.1016/j.jamcollsurg.2019.04.020
17.
HarrisKCurtisJLarsenB, et al.Opioid pain medication use after dermatologic surgery. JAMA Dermatology. 2013;149(3):317-321. doi:10.1001/jamadermatol.2013.1871
18.
FujiiMHHodgesACRussellRL, et al.Post-discharge opioid prescribing and use after common surgical procedure. J Am Coll Surg. 2018;226(6):1004-1012. doi:10.1016/j.jamcollsurg.2018.01.058
19.
HorsleyRDVogelsEDMcFieldDAP, et al.Multimodal postoperative pain control is effective and reduces opioid use after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2019;29(2):394-400. doi:10.1007/s11695-018-3526-z
20.
ReaganKMLO’SullivanDMGannonRSteinbergAC. Decreasing postoperative narcotics in reconstructive pelvic surgery: A randomized controlled trial. Am J Obstet Gynecol. 2017;217(3):325e1-325e10. doi:10.1016/j.ajog.2017.05.041
21.
WickECGrantMCWuCL. Postoperative multimodal analgesia pain management with nonopioid analgesics and techniques: A review. JAMA Surg. 2017;152(7):691-697. doi:10.1001/jamasurg.2017.0898
22.
DuEFarzalZStephensonE, et al.Multimodal analgesia protocol after head and neck surgery: Effect on opioid use and pain control. Otolaryngology-Head Neck Surg (Tokyo). 2019;161(3):424-430. doi:10.1177/0194599819841885
23.
JonesCMPaulozziLJMackKA. Sources of prescription opioid pain relievers by frequency of past-year nonmedical use: United States, 2008-2011. JAMA Intern Med. 2014;174(5):802-803. doi:10.1016/j.physbeh.2017.03.040
24.
BicketMCLongJJPronovostPJAlexanderGCWuCL. Prescription opioid analgesics commonly unused after surgery: A systematic review. JAMA Surg. 2017;152(11):1066-1071. doi:10.1001/jamasurg.2017.0831
25.
FeinbergAEChesneyTRSrikandarajahSAcunaSAMcLeodRS. Opioid use after discharge in postoperative patients. Ann Surg. 2018;267(6):1056-1062. doi:10.1097/SLA.0000000000002591
26.
ThielsCAUblDSYostKJ, et al.Results of a prospective, multicenter initiative aimed at developing opioid-prescribing guidelines after surgery. Ann Surg. 2018;268(3):457-468. doi:10.1097/SLA.0000000000002919
27.
GanTJHabibASMillerTEWhiteWApfelbaumJL. Incidence, patient satisfaction, and perceptions of post-surgical pain: Results from a US national survey. Curr Med Res Opin. 2014;30(1):149-160. doi:10.1185/03007995.2013.860019
28.
Van DijkJFMKappenTHSchuurmansMJvan WijckAJM. The relation between patients' NRS pain scores and their desire for additional opioids after surgery. Pain Pract. 2015;15(7):604-609. doi:10.1111/papr.12217
