Patterns of opioid use and prescribing for outpatient anorectal operations

Swarup, Abhishek; Mathis, Kristina A.; Hill, Maureen V.; Ivatury, Srinivas J.

doi:10.1016/j.jss.2018.04.005

Cited by 20 publications

(18 citation statements)

References 14 publications

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“…Overall, there was no significant difference in pain scores or patient satisfaction measured across groups over time. This evidence supports prior work that opioids may not be needed for appropriate pain control after anorectal surgery, 19,33 and offers the additional support for preserved postoperative function, overall health, and satisfaction with an opioid-sparing ERAS strategy. An interesting finding was that 3 patients in the control group remained on opioids at 30-day follow-up, a 9.4% incidence of NPOU compared to none in the experimental group.…”

Section: Discussionsupporting

confidence: 83%

“…Furthermore, of those that filled their opioid prescription, the median number of pills taken was 4 despite being prescribed a median of 20 pills. 19 Lu et al performed a retrospective review of opioid prescribing patterns in 6294 hemorrhoidectomy patients from a national Military Health System Data Repository. 30 They found 88% filled an initial opioid prescription and 32.9% required a refill; longer length of the index opioid prescription was the only modifiable associated with the second prescription.…”

Section: Discussionmentioning

confidence: 99%

“…Ambulatory anorectal surgery is common, assumed a source of substantial pain, and opioid use postoperatively is pervasive. 19 Thus, study into ERAS and opioid reduction after these cases addresses an important issue in surgical quality impacting many patients.…”

mentioning

confidence: 99%

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A Randomized Controlled Trial Examining the Impact of an Anorectal Surgery Multimodal Enhanced Recovery Program on Opioid Use

et al. 2020

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Background: Anorectal cases may be a common gateway to the opioid epidemic. Opioid reduction is inherent in enhanced recovery after surgery (ERAS) protocols, but little work has evaluated ERAS in these cases. Objective: To determine if ERAS could reduce postoperative opioid utilization in ambulatory anorectal surgery without sacrificing patient pain or satisfaction. Methods: A randomized controlled trial assigned ambulatory anorectal patients to ERAS (experimental) or routine care (surgeon's choice) for pain management (control) over 30-days postoperatively. Primary outcome was overall days of opioid use. Secondary outcomes included pain and satisfaction scores over multiple time points and new persistent opioid use. The Visual Analog Scale, Functional Pain Scale, and EQ-5D-3L measured patientreported pain and satisfaction. Univariate analysis compared outcomes overall and at individual time points. Two-way mixed ANOVA evaluated pain and satisfaction measures between groups and over time. Results: Thirty-two patients were randomized into each arm (64 total). The control group consumed significantly more opioids after discharge (median 121.3MME vs 23.5MME, P < 0.001). Significantly more control patients requested additional narcotics (P ¼ 0.004), made unplanned calls (P ¼ 0.009), and had unplanned clinic visits (P ¼ 0.003). The control group had significantly more days on opioids (mean 14.4 vs 2.2, P < 0.001). Three control patients (9.4%) versus no experimental patients had new persistent opioid use. The mean global health, EQ5D-3L, Visual Analog Scale, and Functional Pain scores were comparable between groups over time. Conclusions: An ERAS protocol in ambulatory anorectal surgery is feasible, and resulted in reduced opioid use, and healthcare utilization, with no difference in pain or patient satisfaction. This challenges the paradigm that extended opioids are needed for effective postoperative pain management.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

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A Randomized Controlled Trial Examining the Impact of an Anorectal Surgery Multimodal Enhanced Recovery Program on Opioid Use

et al. 2020

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“…In a recent prospective study of patients undergoing radical prostatectomy, 77% of postdischarge pain medication went unused. 20 Similar rates of overprescribing have been found following hysterectomy, 21 upper extremity surgery, 22,23 anorectal surgery, 24 dermatologic surgery, 25 and inguinal hernia repair. 26 In addition to this observation, we must also consider the impact that patient variability may have on pain and its perception.…”

Section: Patient Variabilitymentioning

confidence: 77%

Inpatient Opioid Consumption Variability following Total Knee Arthroplasty: Analysis of 4,038 Procedures

Roof

Sullivan

Feng³

et al. 2020

J Knee Surg

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This study examined an early iteration of an inpatient opioid administration-reporting tool, which standardized patient opioid consumption as an average daily morphine milligram equivalence per surgical encounter (MME/day/encounter) among total knee arthroplasty (TKA) recipients. The objective was to assess the variability of inpatient opioid administration rates among surgeons after implementation of a multimodal opioid sparing pain protocol. We queried the electronic medical record at our institution for patients undergoing elective primary TKA between January 1, 2016 and June 30, 2018. Patient demographics, inpatient and surgical factors, and inpatient opioid administration were retrieved. Opioid consumption was converted into average MME for each postoperative day. These MME/day/encounter values were used to determine mean and variance of opioids prescribed by individual surgeons. A secondary analysis of regional inpatient opioid consumption was determined by patient zip codes. In total, 23 surgeons performed 4,038 primary TKA. The institutional average opioid dose was 46.24 ± 0.75 MME/day/encounter. Average intersurgeon (IS) opioid prescribing ranged from 17.67 to 59.15 MME/day/encounter. Intrasurgeon variability ranged between ± 1.01 and ± 7.51 MME/day/encounter. After adjusting for patient factors, the average institutional MME/day/encounter was 38.43 ± 0.42, with average IS variability ranging from 18.29 to 42.84 MME/day/encounter, and intrasurgeon variability ranging between ± 1.05 and ± 2.82 MME/day/encounter. Our results suggest that there is intrainstitutional variability in opioid administration following primary TKA even after controlling for potential patient risk factors. TKA candidates may benefit from the implementation of a more rigid standardization of multimodal pain management protocols that can control pain while minimizing the opioid burden. This is a level of evidence III, retrospective observational analysis.

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“… 17 The use of opioids among patients with IBD is also associated with higher costs, 18 and the amount of opioid use following anal fistulotomy is higher on average than opioid use after other common anorectal operations. 19 …”

Section: Introductionmentioning

confidence: 99%

Health Care Costs and Resource Utilization Among Patients With Crohn’s Disease With and Without Perianal Fistula

Chen

Pedarla

Null

et al. 2021

Inflammatory Bowel Diseases

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Background Perianal fistula (PAF), a complication of Crohn’s disease (CD), is associated with substantial economic costs and poor prognosis. We determined prevalence of PAF CD in the United States and compared costs and health care resource utilization (HRU) of PAF CD patients with matched non-PAF CD patients. Methods This was a retrospective cohort study of claims data from the IBM MarketScan Commercial Database from October 1, 2015, to September 30, 2018. Eligible patients were aged 18 to 89 years with ≥2 CD diagnoses. Patients with PAF CD had ≥1 PAF diagnosis or procedure code and were matched with non-PAF CD patients. Cumulative prevalence of PAF CD in the US population was calculated across total patients in MarketScan. All-cause and gastrointestinal (GI)-related costs and HRU were compared between groups using a generalized linear model (GLM). Results Cumulative 3-year prevalence of PAF was 7.70% of patients with CD (N = 81,862) and 0.01% of the US population. Among PAF CD (n = 1218) and matched non-PAF CD (n = 4095) patients, most all-cause costs and HRU were GI-related. Mean total all-cause and GI-related health care costs per patient and per year for PAF CD were $85,233 and $71,612, respectively, vs $40,526 and $29,458 for non-PAF CD (P < .0001). Among PAF CD vs non-PAF CD patients, GLM-adjusted proportions of patients with GI-related inpatient, outpatient, or pharmacy visits, mean GI-related inpatient length of stay, and mean GI-related surgeries were higher (P < .0001 for all comparisons). Conclusions Costs and HRU are significantly higher for patients with PAF CD vs non-PAF CD patients, highlighting the economic burden of the disease.

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Patterns of opioid use and prescribing for outpatient anorectal operations

Cited by 20 publications

References 14 publications

A Randomized Controlled Trial Examining the Impact of an Anorectal Surgery Multimodal Enhanced Recovery Program on Opioid Use

A Randomized Controlled Trial Examining the Impact of an Anorectal Surgery Multimodal Enhanced Recovery Program on Opioid Use

Inpatient Opioid Consumption Variability following Total Knee Arthroplasty: Analysis of 4,038 Procedures

Health Care Costs and Resource Utilization Among Patients With Crohn’s Disease With and Without Perianal Fistula

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