Trainees as Agents of Change in the Opioid Epidemic: Optimizing the Opioid Prescription Practices of Surgical Residents

Chiu, Alexander S.; Healy, James M.; DeWane, Michael P.; Longo, Walter E.; Yoo, Peter S.

doi:10.1016/j.jsurg.2017.06.020

Cited by 122 publications

(116 citation statements)

References 28 publications

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“…Large, prospective, multi‐institutional trials may further clarify these data. Nonetheless, in light of societal trends, including the rise of evidence‐based medicine, interest in cost‐effective practices, and the rising opioid epidemic, these findings are timely and useful, as formalized pain training is lacking in residency training and continuing medical education …”

Section: Discussionmentioning

confidence: 99%

Perioperative analgesia for patients undergoing endoscopic sinus surgery: an evidence‐based review

Svider

Nguyen

Yuhan

et al. 2018

Int Forum Allergy Rhinol

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There is evidence supporting the use of NSAIDs and gabapentin for the control of pain after endoscopic sinus surgery. Acetaminophen, α-agonists, and local anesthetics are also viable options for postoperative analgesia. Familiarity with these data is essential to facilitate the use of opioid alternatives. Further large-scale, multi-institutional, randomized trials are needed to provide conclusive recommendations for these perioperative analgesics.

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Section: Discussionmentioning

confidence: 99%

Perioperative analgesia for patients undergoing endoscopic sinus surgery: an evidence‐based review

Svider

Nguyen

Yuhan

et al. 2018

Int Forum Allergy Rhinol

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“…Among most programs offering such education, the time dedicated was only an hour. Strengthening the amount and quality of educational resources aimed at appropriate opioid prescription may be an important consideration for minimizing the unnecessary prescription and subsequent misuse of these medications …”

Section: Discussionmentioning

confidence: 99%

“…Strengthening the amount and quality of educational resources aimed at appropriate opioid prescription may be an important consideration for minimizing the unnecessary prescription and subsequent misuse of these medications. [18][19][20] Another finding highlighting a lack of consensus was significant geographic discrepancy (Fig. 2).…”

Section: Discussionmentioning

confidence: 99%

Opioid prescribing patterns among otolaryngologists: Crucial insights among the medicare population

et al. 2018

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“…Although there has been a shift toward encouraging prescribing of hydromorphone (over Tylenol 3) owing to its safety profile and more homogeneous metabolism, attending surgeons' practice patterns are more challenging to modify than those of their junior counterparts. 13 We also observed variability in prescribing of adjunct analgesia medications in the postoperative period. Apart from cardiac, thoracic and vascular surgeons, a proportion of surgeons reported never prescribing acetaminophen.…”

Section: Discussionmentioning

confidence: 81%

“…Our findings also confirm existing data showing that Tylenol 3, Percocet and Dilaudid (hydromorphone, Rhodes Pharma) continue to be the most frequently prescribed opioids in Canada. 13 Among staff surgeons, Tylenol 3 was the most frequently prescribed opioid, whereas among surgical residents, the preferred opioid was hydromorphone, possibly owing to the influence of acute pain services' use of hydromorphone in patient-controlled analgesia for postoperative pain. In contrast, attending surgeons tend to be more strongly influenced by previous practice patterns.…”

Section: Discussionmentioning

confidence: 99%

Postoperative opioid-prescribing patterns among surgeons and residents at universityaffiliated hospitals: a survey study

Goel

Feinberg

McGuiness

et al. 2020

CJS

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Background: Overprescribing of opioids to patients following surgery is a public health concern, as unused pills may be diverted and contribute to opioid misuse and dependence. The objectives of this study were to determine current opioid-prescribing patterns for common surgical procedures, factors that affect surgeons' prescribing behaviour and their perceived ability to manage patients with opioid use disorder. Methods: Survey participants included all consultant and trainee surgeons at the University of Toronto. The survey, which was administered electronically, included 52 multiple-choice, rank-order and open-text questions eliciting information on current prescribing patterns, prescribing of adjunct pain medications, and education and other factors related to opioid prescribing. Staff surgeons were also asked about how they manage patients with a suspected opioid issue. Results: Eighty surgical trainees and 40 staff surgeons responded to the survey (response rate 32%). Five staff surgeons (12%) felt adequately educated to prescribe pain medications (including opioids) at discharge. Staff surgeons prescribed Tylenol 3 more frequently than other opioids. Twenty (51%) of 39 staff surgeons reported that they sought further help for their patients when an opioid use disorder was suspected. Conclusion: Our results support existing studies showing a large degree of variability in postoperative opioid prescribing. Institutional guidelines have been shown to be effective in curbing excessive opioid prescribing without increasing unnecessary emergency department visits for uncontrolled pain. Thus, there is an opportunity to develop institutional guidelines to educate surgical teams in the prescribing of opioids and about services available for patients with a substance use disorder. Contexte : La surprescription d'opioïdes aux patients après une chirurgie représente un problème de santé publique car il y a un risque que les comprimés inutilisés soient détournés et utilisés à mauvais escient, voire qu'ils causent la dépendance. Cette étude avait pour objectif d'identifier les modes actuels de prescription des opioïdes pour les chirurgies courantes, les facteurs qui influent sur les habitudes de prescription des chirurgiens et leur capacité perçue à prendre en charge les cas de mésusage des opioïdes. Méthodes : Les participants au sondage étaient tous les chirurgiens en poste et en formation à l'Université de Toronto. Ce sondage administré par voie électronique comprenait 52 questions (choix multiples, échelles ordinales et ouvertes) qui visaient à recueillir des renseignements sur les modes actuels de prescription, la prescription d'analgésiques d'appoint, l'enseignement au patient et autres éléments relatifs à la prescription des opioïdes. Les chirurgiens en poste ont aussi été interrogés sur leur gestion des cas présumés de mésusage des opioïdes. Résultats : Quatre-vingt chirurgiens en formation et 40 chirurgiens en poste ont répondu au sondage (taux de réponse, 32 %). Cinq chirurgiens en poste (12 %) se sont estimés...

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Trainees as Agents of Change in the Opioid Epidemic: Optimizing the Opioid Prescription Practices of Surgical Residents

Cited by 122 publications

References 28 publications

Perioperative analgesia for patients undergoing endoscopic sinus surgery: an evidence‐based review

Perioperative analgesia for patients undergoing endoscopic sinus surgery: an evidence‐based review

Opioid prescribing patterns among otolaryngologists: Crucial insights among the medicare population

Postoperative opioid-prescribing patterns among surgeons and residents at universityaffiliated hospitals: a survey study

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