Opioid Medication Use in the Surgical Patient: An Assessment of Prescribing Patterns and Use

Tan, Wen Hui; Yu, Jennifer; Feaman, Sara; McAllister, Jared; Kahan, Lindsey G.; Quasebarth, Mary; Blatnik, Jeffrey A.; Eagon, J. Christopher; Awad, Michael M.; Brunt, L. Michael

doi:10.1016/j.jamcollsurg.2018.04.032

Cited by 81 publications

(45 citation statements)

References 29 publications

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“…Conversely, every patient had leftover opioid pills at the end of the study. These results are consistent with a recent report by Tan et al, which showed that postoperative patients following open and laparoscopic abdominal surgical procedures required fewer than half of the opioid pills prescribed. Although there are obvious differences in pre‐ and postoperative characteristics between patients undergoing abdominal and rhinologic surgery, the phenomenon of opioid overprescribing appears to span many surgical disciplines.…”

Section: Discussionsupporting

confidence: 93%

Opioid analgesic use and patient‐reported pain outcomes after rhinologic surgery

Riley

Kim

Sclafani

et al. 2018

Int Forum Allergy Rhinol

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Background: Opioid-based analgesics are routinely prescribed a er elective rhinologic surgery. Balancing appropriate pain management while avoiding overprescription necessitates an evidence-based approach.Methods: Patients undergoing elective rhinologic surgery, including endoscopic sinus surgery (ESS), septoplasty, or ESS with septoplasty, were prospectively enrolled. Patients completed demographic and psychometric questionnaires assessing a itudes toward pain, baseline anxiety, and depression before surgery. Postoperatively, patients documented peak pain levels (0-100 visual analog scale) and daily prescription and nonprescription medication requirements over a 2-week period. Results:Of the 42 patients enrolled, 15 underwent ESS, 14 septoplasty, and 13 ESS with septoplasty. Five patients (11.9%) reported a history of chronic pain before surgery. Patients were given a median of 30 opioid pain pills a er surgery: acetaminophen with codeine 325/30 mg (10 patients) or oxycodone with acetaminophen 5/325 mg (32 patients). Patients had a median of 27 pills le over at the end of the study period. Median peak pain levels for all procedures were 22 (range, 0-94) on day 0, 26.5 (range, 0-86) on day 1, 8.5 (range, 0-85) on day 3, and 3 (range, 0-52) on day 7. Median opioid requirements measured in morphine milligram equivalents (MME) over those same days were 6.0, 4.1, 0, and 0, respectively. Conclusion:Postoperative pain a er elective rhinologic surgery appears to peak over the first 3 days and decreases rapidly a erward. Most patients require a few doses of opioid analgesics. Opioid requirements and pain levels did not vary based on surgeon, type and extent of surgery, and demographic factors. Judicious prescribing of opioid medication a er rhinologic surgery represents a practical opportunity for rhinologists and otolaryngologists to reduce opioid overprescription and abuse. C 2018 ARS-AAOA, LLC. How to Cite thisArticle: Riley CA, Kim M, Sclafani AP, et al. Opioid analgesic use and patient-reported pain outcomes a er rhinologic surgery. Int Forum Allergy Rhinol. 2019;9:339-344.

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Section: Discussionsupporting

confidence: 93%

Opioid analgesic use and patient‐reported pain outcomes after rhinologic surgery

Riley

Kim

Sclafani

et al. 2018

Int Forum Allergy Rhinol

View full text Add to dashboard Cite

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“…The primary outcome was total opioid dose per index prescription in morphine milligram equivalent (MME), a measure that reflects both the dose and number of tablets in the entire prescription and standardizes across opioid type. 24 Although the outcome MME/day is commonly used in the literature, MME/prescription has been used previously in opioid prescribing policy 25,26 and hospital and health system-based studies 27,28 and allowed us to report change in the total volume of opioids in a new prescription. Further, by using total MME/prescription, we were able to distinguish between true decreases in prescribing and changes in dosing instructions (i.e., increasing the dose or frequency to fit within 5 days).…”

Section: Discussionmentioning

confidence: 99%

Impact of a State Opioid Prescribing Limit and Electronic Medical Record Alert on Opioid Prescriptions: a Difference-in-Differences Analysis

et al. 2019

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“…4,[6][7][8] Studies have shown there is a large MED range of opiate medications provided to patients after common surgeries, 9 and that a majority of patients report unused leftover opioid medication after procedures. 7,8,10 Specifically, unanticipated visits after ureteroscopy for stone disease has been reported to be 6.6%, and the majority of these visits are made due to pain. 5,11 An important finding of our study is that most patients before stone surgery have had opiate exposure within the previous 30 days, and a significant proportion have had multiple prescriptions.…”

Section: Discussionmentioning

confidence: 99%

“…After surgery, providing a standardized MED per postoperative opiate prescription may help minimize the quantity of opiates prescribed and/or unused by patients. 10 It is important to note that patients who have had prior exposure to opiate medications seem to be at greater risk for continued opiate use, and these at-risk patients may benefit most from targeted counseling regarding the risks and alternatives to opiate medications. Furthermore, providing prescriptions for nonopiate medications including nonsteroidal anti-inflammatory drugs, alpha-blockers, oxybutynin, and phenazopyridine may result in decreased opiate requirement.…”

Section: Discussionmentioning

confidence: 99%

Opiate Exposure and Predictors of Increased Opiate Use After Ureteroscopy

Kang

Shu

Herrell

et al. 2019

Journal of Endourology

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Objective: Kidney stone formers are at risk for opioid dependence. The aim of this study is to describe opiate exposure and determine predictors of prolonged opiate use among kidney stone formers after surgery. Materials and Methods: A retrospective review was performed among patients who underwent ureteroscopy for upper tract stone disease. Prescription data were ascertained from a statewide prescribing database. Demographic data and surgical factors were collected from the electronic medical record. Predictors of additional postsurgery prescriptions filled within 30 days and persistent opiate use 60 days after ureteroscopy were determined. Results: Among 208 patients, 127 (61%) had received preoperative opiate prescriptions within 30 days before surgery. Overall, 12% (n = 25) of patients required an additional opiate prescription within 30 days after ureteroscopy, and 7% (n = 14) of patients continued to use opiate medications more than 60 days postoperatively. Patients continuing to use opiates long-term were not chronic opiate users. For both outcomes, preoperative opiate exposure, including number of prescriptions, days prescribed, and unique providers had significant associations (all p < 0.05). Additionally, younger age (p = 0.049) was associated with obtaining an additional opiate prescription within 30 days. Lower BMI (p = 0.02) and higher ASA score (p = 0.03) were predictors of continued opiate use more than 60 days after ureteroscopy. Conclusions: The majority of stone formers have had opiate exposure before surgery, often from multiple providers. Approximately 1 in 8 stone formers who undergo ureteroscopy require additional opiate prescriptions within 30 days. A small but significant population receive opiates beyond the immediate postoperative period.

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Opioid Medication Use in the Surgical Patient: An Assessment of Prescribing Patterns and Use

Abstract: Postoperative patients might consume less than half of the opioid pills they are prescribed. More research is needed to standardize opioid prescriptions for postoperative pain management while reducing opioid diversion.

Cited by 81 publications

References 29 publications

Opioid analgesic use and patient‐reported pain outcomes after rhinologic surgery

Opioid analgesic use and patient‐reported pain outcomes after rhinologic surgery

Impact of a State Opioid Prescribing Limit and Electronic Medical Record Alert on Opioid Prescriptions: a Difference-in-Differences Analysis

Opiate Exposure and Predictors of Increased Opiate Use After Ureteroscopy

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