Predictors of low and high opioid tablet consumption after inguinal hernia repair: an ACHQC opioid reduction task force analysis

Perez, Arielle J.; Petro, Clayton C.; Higgins, Rana M.; Huang, Liyan; Phillips, Sharon; Warren, Jeremy A.; Dews, Teresa E.; Reinhorn, Michael

doi:10.1007/s10029-022-02661-3

Cited by 6 publications

(5 citation statements)

References 46 publications

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“…The correlation of increased consumption with increased prescribing was demonstrated by another recent study from the ACHQC. 16 In this study, analyzing 1937 inguinal patients, increased prescribing (in 7-tablet increments) significantly increased the likelihood of high-opioid consumption (OR 3.32; 95% CI 2.64-4.18). Conversely, decreased opioid prescribing (in 7-tablet increments) significantly increased the likelihood of consuming zero opioids (OR 2.27; 95% CI 1.96-2.62).…”

Section: Discussionmentioning

confidence: 67%

“…The correlation of increased consumption with increased prescribing was demonstrated by another recent study from the ACHQC. 16 In this study, analyzing 1937 inguinal patients, increased prescribing (in 7-tablet increments) significantly increased the likelihood of high-opioid consumption (OR ). Thus, controlling for numerous other co-morbidities and operative factors, the single greatest factor in predicting high or low opioid consumption was the volume of prescribed opioids.…”

Section: Discussionmentioning

confidence: 91%

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A Standardized Protocol for Opioid Prescribing After Surgery Decreases Total Morphine Equivalents Prescribed

Millard,

Hahn,

Schumann

et al. 2023

The American Surgeon™

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Introduction Perioperative opioid analgesia has been extensively reexamined during the opioid epidemic. Multiple studies have demonstrated over prescription of opioids, demonstrating the need for change in prescribing practices. A standard opioid prescribing protocol was implemented to evaluate opioid prescribing trends and practices. Objectives To evaluate opioid use after primary ventral, inguinal, and incisional hernia repair and to assess clinical factors that may impact opioid prescribing and consumption. Secondary outcomes include the number of refills, patients without opioid requirement, difference in opioid use based on patient characteristics and adherence to prescribing protocol. Methods This is a prospective observational study examining patients undergoing inguinal, primary ventral and incisional hernias between February and November 2019. A standardized prescribing protocol was implemented and utilized for postoperative prescribing. All data was captured in the abdominal core health quality collaborative (ACHQC) and opioid use was standardized via morphine milligram equivalents (MME). Results 389 patients underwent primary ventral, incisional, and inguinal hernia repair, with a total of 285 included in the final analysis. 170 (59.6%) of patients reported zero opioid use postoperatively. Total opioid MME prescribed and high MME consumption were significantly higher after incisional hernia repair with a greater number of refills were required. Compliance with prescribing protocol resulted in lower MME prescription, but not actual lower MME consumption. Conclusions Implementation of a standardized protocol for opioid prescribing after surgery decreases the total MME prescribed. Compliance with our protocol significantly reduced this disparity, which has the potential for decreasing abuse, misuse, and diversion of opioids by better estimating actual postoperative analgesic requirements.

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Section: Discussionmentioning

confidence: 67%

“…The correlation of increased consumption with increased prescribing was demonstrated by another recent study from the ACHQC. 16 In this study, analyzing 1937 inguinal patients, increased prescribing (in 7-tablet increments) significantly increased the likelihood of high-opioid consumption (OR ). Thus, controlling for numerous other co-morbidities and operative factors, the single greatest factor in predicting high or low opioid consumption was the volume of prescribed opioids.…”

Section: Discussionmentioning

confidence: 91%

A Standardized Protocol for Opioid Prescribing After Surgery Decreases Total Morphine Equivalents Prescribed

Millard,

Hahn,

Schumann

et al. 2023

The American Surgeon™

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“…Inguinal hernia repair is one of the most common surgeries, with an estimated 800,000 procedures reported each year in the US [27]. Herniorrhaphy reliably produces persistent pain symptoms typically lasting over 72 h from the time of surgery.…”

Section: Conclusion and Discussionmentioning

confidence: 99%

CPL-01, an investigational long-acting ropivacaine, demonstrates safety and efficacy in open inguinal hernia repair

Xu,

Zimmerman,

Bertoch

et al. 2024

Hernia

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Background There is an unmet medical need for effective nonopioid analgesics that can decrease pain while reducing systemic opioid use. CPL-01, an extended-release injectable formulation of ropivacaine, is designed to safely provide analgesia and reduce or eliminate opioid use in the postoperative period. Methods Subjects undergoing open inguinal hernia with mesh were prospectively randomized to 1 of 3 doses of CPL-01 (10, 20, or 30 ml of 2% CPL-01, n = 14, 12, and 14, respectively), Naropin (150 mg, n = 40), or saline placebo (n = 13) infiltrated into the surgical site prior to closure. Pain and rescue medication usage was assessed, and Numeric Rating Scale (NRS) pain scores were adjusted for opioid usage using windowed worst observation carried forward (wWOCF) imputation. The primary efficacy endpoint was the mean area under the curve (AUC) of the NRS pain intensity scores with activity. Results Ninety-three subjects were treated, and 91 subjects completed 72 h of post-operative monitoring. Subjects who received the highest dose of CPL-01 in Cohort 3 showed a clinically meaningful reduction in postoperative pain intensity scores, which was the lowest value for any treatment in all cohorts, showing a trend towards statistical significance as compared to the pooled placebo group (p = 0.08), and numerically better than the 40 subjects who received Naropin. Opioid use through 72 h in subjects who received CPL-01 in Cohort 3 was approximately half of that shown in the placebo and Naropin groups; approximately 2/3 of the CPL-01 subjects (9/14) required no opioids at all through the first 72 h after the operation. More CPL-01 subjects avoided severe pain and were ready for discharge earlier than other groups. CPL-01 was safe and well-tolerated, with no clinically meaningful safety signals, and showed predictable and consistent extended-release pharmacokinetics. Conclusion Results suggest that CPL-01 may be the first long-acting ropivacaine to address postoperative pain while reducing the need for opioids.

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“…For example, coprescribing of opioids, benzodiazepines, and skeletal muscle relaxants is common among women undergoing implant-based breast reconstruction, potentially because some guidelines recommended this practice to improve pain and mitigate postoperative muscle contraction 4,5,14–21. Moreover, recent evidence suggests that surgeon prescribing is one of the primary drivers of postoperative opioid use, and the most modifiable 22. Given the prevalence of surgical care and perioperative opioid prescribing, reducing high-risk surgical opioid prescribing is a key step toward mitigating prescription opioid-related harms.…”

mentioning

confidence: 99%

Safety and Distribution of Opioid Prescribing by U.S. Surgeons

Waljee

Gunaseelan²,

Bicket

et al. 2023

Annals of Surgery

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Objective: To estimate high-risk prescribing patterns among opioid prescriptions from U.S. surgeons; to characterize the distribution of highrisk prescribing among surgeons. Background: National data on the prevalence of opioid prescribing and high-risk opioid prescribing by U.S. surgeons are lacking. Methods: Using the IQVIA Prescription Database, which reports dispensing from 92% of U.S. pharmacies, we identified opioid prescriptions from surgeons dispensed in 2019 to patients ages ≥ 12 years. "High-risk" prescriptions were characterized by: days supplied > 7, daily dosage ≥ 50 oral morphine equivalents (OMEs), opioid-benzodiazepine overlap, and extended-release/long-acting opioid. We determined the proportion of opioid prescriptions, total OMEs, and high-risk prescriptions accounted for by "high-volume surgeons" (those in the ≥ 95th percentile for prescription counts). We used linear regression to identify characteristics associated with being a high-volume surgeon. Results: Among 15,493,018 opioid prescriptions included, 7,036,481 (45.4%) were high-risk. Among 114,610 surgeons, 5753 were in the 95th percentile or above for prescription count, with ≥ 520 prescriptions dispensed in 2019. High-volume surgeons accounted for 33.5% of opioid prescriptions, 52.8% of total OMEs, and 44.2% of high-risk prescriptions. Among high-volume surgeons, 73.9% were orthopedic surgeons and 60.6% practiced in the South. Older age, male sex, specialty, region, and lack of affiliation with academic institutions or health systems were correlated with high-risk prescribing. Conclusions:The top 5% of surgeons account for 33.5% of opioid prescriptions and 45.4% of high-risk prescriptions. Quality improvement initiatives targeting these surgeons may have the greatest yield given their outsized role in high-risk prescribing.

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Predictors of low and high opioid tablet consumption after inguinal hernia repair: an ACHQC opioid reduction task force analysis

Cited by 6 publications

References 46 publications

A Standardized Protocol for Opioid Prescribing After Surgery Decreases Total Morphine Equivalents Prescribed

A Standardized Protocol for Opioid Prescribing After Surgery Decreases Total Morphine Equivalents Prescribed

CPL-01, an investigational long-acting ropivacaine, demonstrates safety and efficacy in open inguinal hernia repair

Safety and Distribution of Opioid Prescribing by U.S. Surgeons

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