Wide Variation and Excessive Dosage of Opioid Prescriptions for Common General Surgical Procedures

Hill, Maureen V.; McMahon, Michelle L.; Stucke, Ryland S.; Barth, Richard J.

doi:10.1097/sla.0000000000001993

Cited by 768 publications

(710 citation statements)

References 16 publications

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“…Our findings of opioid over-prescription are similar to recent reports in other surgical cohorts 4–7 , including cesarean section. 8,9 However, few studies have examined whether individual patient factors predict outpatient opioid use.…”

Section: Discussionsupporting

confidence: 91%

“…Recent studies have found that most patients undergoing various surgical procedures 4–7 , including cesarean section 8,9 , are prescribed opioids in excess of what they use. Despite the era of personalized medicine, most studies did not investigate whether individual patient factors influence opioid use and postsurgical pain during the postoperative period.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Opioid Prescribing Patterns, Patient Use, and Postoperative Pain After Hysterectomy for Benign Indications

As‐Sanie¹,

Till²,

Mowers³

et al. 2017

Obstetrics &Amp; Gynecology

125

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Objective To quantify physician prescribing patterns and patient opioid use in the two weeks after hysterectomy at an academic institution, and determine whether patient factors predict postsurgical opioid use and pain recovery. Methods We conducted a prospective quality initiative study by recruiting all English-speaking patients undergoing hysterectomy for benign, non-obstetric indications at a university hospital between August and December 2015, excluding those with major medical morbidities or substance abuse. Before hysterectomy, patients completed the Fibromyalgia Survey, a validated measure of centralized pain. Following hysterectomy, opioid use (converted to oral morphine equivalents) and pain scores (0–10 numeric rating scale) were collected by a daily diary and a structured telephone interview 14 days after surgery. Primary outcomes were total opioid prescribed and consumed in the 2 weeks after hysterectomy. Secondary outcomes included daily opioid use and daily pain severity for 14 days after hysterectomy. Results Of 103 eligible patients, 102 (99%) agreed to participate, including 44 (43.1%) laparoscopic, 42 (41.2%) vaginal, and 16 (15.7%) abdominal hysterectomies. Telephone surveys were completed on 89 (87%) participants, diaries were returned from 60 (59%) participants. Diary non-responders had different baseline characteristics than non-responders. Median amount of opioid prescribed was 200 oral morphine equivalents (interquartile range (IQR) 150–250). Patients reported using approximately half of the opioids prescribed, with a median excess of 110 morphine equivalents (IQR 40–150). The best fit model of total opioid consumption identified preoperative Fibromyalgia Score, overall body pain, preoperative opioid use, prior endometriosis, abdominal hysterectomy (compared to laparoscopic), and uterine weight as significant predictors. Highest tertile of Fibromyalgia Score was associated with greater daily opioid consumption (13.9 [95% CI 3.0 – 24.8] greater OME at baseline, p=0.02). Conclusion Gynecologists at a large academic medical center prescribe twice the amount of opioids than the average patient uses after hysterectomy. A personalized approach to prescribing opioids for postoperative pain should be considered.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Opioid Prescribing Patterns, Patient Use, and Postoperative Pain After Hysterectomy for Benign Indications

As‐Sanie¹,

Till²,

Mowers³

et al. 2017

Obstetrics &Amp; Gynecology

125

View full text Add to dashboard Cite

show abstract

“…Consistent with current literature, the physician distribution graphs keep showing wide variation in opioid prescribing. 6 Physicians who are outside of the data boundaries of reasonable variation for standardised procedures as set by our hospitals pain specialists are easily identifiable.…”

Section: Fig 1 Distribution Of Surgeons By Number Of Opioid Pills Thementioning

confidence: 99%

Overprescribing is major contributor to opioid crisis

Makary¹,

Overton²,

Wang³

2017

BMJ

144

107

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“…A recent study in ERAS for colorectal surgery showed that despite a reduction in inpatient postoperative opioids as a result of consistent compliance with multimodal and regional analgesia, patients were just as likely to be prescribed opioids at hospital discharge. 18 These findings, described by others as well, were primarily attributed to systems-level failures in time-of-discharge communication, prescription practices, 4,19 and patient follow-up coordination.…”

mentioning

confidence: 89%

Perioperative Esmolol and Opioids

Grant

Ouanes

Joshi

2018

Regional Anesthesia and Pain Medicine

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Wide Variation and Excessive Dosage of Opioid Prescriptions for Common General Surgical Procedures

Abstract: There is wide variability in opioid prescriptions for common general surgery procedures. In many cases excess pills are prescribed. Using our ideal number, surgeons can adequately treat postoperative pain and markedly decrease the number of opioids prescribed.

Cited by 768 publications

References 16 publications

Opioid Prescribing Patterns, Patient Use, and Postoperative Pain After Hysterectomy for Benign Indications

Opioid Prescribing Patterns, Patient Use, and Postoperative Pain After Hysterectomy for Benign Indications

Overprescribing is major contributor to opioid crisis

Perioperative Esmolol and Opioids

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