According to the results of a recent study, the quantity of opioid prescribed after surgery is associated with higher patient-reported opioid consumption, which should be considered when developing better practices for prescribing for pain management.
The authors said the objectives were to compare postoperative opioid prescription size and patient consumption and to identify factors associated with postoperative opioid consumption. They found that patients used 27% of the opioids prescribed to them. Prescription size had the strongest association with opioid consumption after surgery, with patients using an additional 5 pills for every 10 extra pills prescribed.
The research follows concern that opioid pills leftover after surgery may be diverted to others in the community, contributing to opioid use disorders.
The data came from the Michigan Surgical Quality Collaborative (MSQC), a statewide consortium that shares surgical outcomes data to develop and implement quality improvement strategies. The study drew from 33 health systems in Michigan. Patients were included if they were at least 18 years old, undergoing surgery, and were prescribed an opioid after surgery. Surgical procedures that occurred between January 1, 2017 and September 30, 2017 were included if they were performed in at least 25 patients, according to the researchers.
In this retrospective analysis, 2392 patients underwent 1 of 12 surgical procedures. The main outcome was patient-reported opioid consumption in oral morphine equivalents (OME).
Overall, the quantity of opioid prescribed was significantly higher than patient-reported opioid consumption (median, 30 pills; IQR, 27-45 pills of hydrocodone/acetaminophen, 5/325 mg, vs 9 pills; IQR, 1-25 pills; P < .001). The quantity of opioid prescribed had the strongest association with patient-reported opioid consumption, with patients using 0.53 more pills (95% CI, 0.40-0.65; P < .001) for every additional pill prescribed
Consumption was also observed to be significantly associated with patient-reported pain in the week after surgery. When compared to those who report no pain, patients used an average of 9 more pills if they reported moderate pain and 16 more pills if they reported severe pain. Other factors that were noted to be risk factors included history of tobacco use, American Society of Anesthesiologists class age, procedure type, and inpatient surgery status.
“Our findings build on existing work demonstrating significant disparities between the quantity of opioids prescribed and consumed after surgery, posing a risk for diversion to other patients and the community,” concluded the study. “Importantly, overprescribing occurred for all procedures included in this study, from relatively minor to major operations. Most patients who receive opioids after surgery do not dispose of leftover medication.”
In addition, excessive opioid prescribing was found to be widespread, no matter the size of the institution. The recognition of overprescribing and its effect on patient consumption of opioids after surgery is critical to improving prescribing practices, the authors said. Predictive modeling based on patient characteristics also have the potential to improve postoperative prescribing practice, they said.
Howard R, Fry B, Gunaseelan V, et al. Association of opioid prescribing with opioid consumption after surgery in Michigan. [published online November 7, 2018]. JAMA Surg. doi: 10.1001/jamasurg.2018.4234.