Guideline for Discharge Opioid Prescriptions after Inpatient General Surgical Procedures

Assessment of Opioid Prescribing Practices Before and After Implementation of a Health System Intervention to Reduce Opioid Overprescribing

“…Some have argued that the opioid consumption during the last 24 hours before discharge is the best way to determine prescription volume following discharge. 37 Indeed, enhanced access to this information was 1 of the tools used in this project. The ability to electronically prescribe opioids remotely through the EMR will facilitate smaller-volume initial prescriptions because a second one can be provided more easily and only if needed.…”

“…The drive to standardization for postsurgical prescribing has been facilitated with published reports of the degree of overprescribing and more appropriate postoperative starting doses. 37,38 We are aware that reducing a community’s opioid reservoir, may, in the short run, increase the number of persons who seek illicit street opioids and thus increase their risk of death. However, we regard cautious prescribing and opioid stewardship as a shared commitment to the long-term health of our community.…”

Trends in patient procurement of postoperative opioids and route of hysterectomy in the United States from 2004 through 2014

“…Hill et al, in 2017 described a postoperative prescription guideline based on the opioids used 24 hours prior to discharge. Using their guidelines, postoperative opioid prescriptions decreased by 40% [32]. More surgical subspecialties need to evaluate postoperative prescription patterns to avoid unnecessary opioid exposure contributing to the epidemic.…”

Pain and opioid prescriptions vary by procedure after breast surgery

“…At our three‐site academic institution, pain following breast surgery for oncologic treatment or prevention reasons varied by procedure, yet at each of the three evaluated institutions patients received similar prescription amounts. These prescribed amounts exceeded current guidelines, which is of concern as those who are overprescribed often have unused opioids remaining after surgery that may not be properly disposed …”

“…Therefore, understanding opioid needs and prescribing patterns after specific operations is essential . Recent studies have determined that the majority of patients undergoing general surgery procedures would have their pain needs met with less than 15 opioid pills (equivalent to 5 mg of oxycodone), and between 10 and 15 pills for oncologic breast‐specific surgery . Furthermore, it has been shown that new persistent opioid use is common following breast surgery, with 10% of patients undergoing breast surgery with immediate breast reconstruction (IBR) requiring opioids beyond 3 months postoperatively .…”