Comparing Clinician Consensus Recommendations to Patient-reported Opioid Use Across Multiple Hospital Systems

Abstract

Objective: We compare consensus recommendations for 5 surgical procedures to prospectively collected patient consumption data. To address local variation, we combined data from multiple hospitals across the country. Summary of Background Data: One approach to address the opioid epidemic has been to create prescribing consensus reports for common surgical procedures. However, it is unclear how these guidelines compare to patientreported data from multiple hospital systems. Methods: Prospective observational studies of surgery patients were completed between 3/2017 and 12/2018. Data were collected utilizing postdischarge surveys and chart reviews from 5 hospitals (representing 3 hospital systems) in 5 states across the USA. Prescribing recommendations for 5 common surgical procedures identified in 2 recent consensus reports were compared to the prospectively collected aggregated data. Surgeries included: laparoscopic cholecystectomy, open inguinal hernia repair, laparoscopic inguinal hernia repair, partial mastectomy without sentinel lymph node biopsy, and partial mastectomy with sentinel lymph node biopsy. Results: Eight hundred forty-seven opioid-naı ¨ve patients who underwent 1 of the 5 studied procedures reported counts of unused opioid pills after discharge. Forty-one percent did not take any opioid medications, and across all surgeries, the median consumption was 3 5 mg oxycodone pills or less. Generally, consensus reports recommended opioid quantities that were greater than the 75th percentile of consumption, and for 2 procedures, recommendations exceeded the 90th percentile of consumption. Conclusions: Although consensus recommendations were an important first step to address opioid prescribing, our data suggests that following these recommendations would result in 47%-56% of pills prescribed remaining unused. Future multi-institutional efforts should be directed toward refining and personalizing prescribing recommendations.

CDC Clinical Practice Guideline for Prescribing Opioids for Pain—United States, 2022

“…Since 2017, multiple studies have found that many patients do not use all prescribed opioids after surgery and that prescribing a lower quantity of opioids postoperatively is associated with less opioid use without increases in pain score or in requests for refills of pain medication and without reductions in satisfaction with pain management ( 77 – 79 ). One study found that, after five common surgical procedures, median opioid consumption was three 5-mg oxycodone pills or less, and that following consensus recommendations intended to reduce unnecessary postoperative opioid prescribing published in 2018 and 2019 would still result in 47%–56% of pills prescribed remaining unused ( 248 ). Evidence exists of variation in opioid needs across patients undergoing the same procedures attributable to factors including pain at discharge and previous opioid use ( 249 ).…”

Nonresponse adjustment using clinical and perioperative patient characteristics is critical for understanding post-discharge opioid consumption

“…1 In an effort to standardize prescribing practices and limit overprescribing, many institutions have created guidelines based on expert clinical consensus to help surgeons determine how many opioids to prescribe after a given procedure. 2,3 While an important first step, these consensus-based guidelines would still result in significant excess opioid prescribing. 2 Recommendations regarding appropriate prescription sizes benefit from real-world evidence in the form of post-discharge opioid consumption data from patients.…”

“…2,3 While an important first step, these consensus-based guidelines would still result in significant excess opioid prescribing. 2 Recommendations regarding appropriate prescription sizes benefit from real-world evidence in the form of post-discharge opioid consumption data from patients. The few studies using real consumption data to guide post-surgical prescribing have demonstrated significant clinical improvement in opioid prescribing patterns.…”

“…The few studies using real consumption data to guide post-surgical prescribing have demonstrated significant clinical improvement in opioid prescribing patterns. 2,[4][5][6][7] However, only a few groups have collected this data at scale because it requires significant resources and is labor-intensive to collect.…”

“…8,9 The consumption data it produced proved useful in guiding many institutional prescribing protocols and in evaluating the validity of existing guidelines and prescribing practices. 2,8,10 However, the telephone-based method of data collection was not easy to scale to include additional procedures or institutions without a concomitant increase in staffing. In an effort to reduce the manual component of data collection, we developed a new, automated method of data collection.…”