R. Howard1, J. Lee1, C. Brummett1, J. Waljee1, M. Englesbe1 1University Of Michigan,Ann Arbor, MI, USA
Introduction:
Mortality related to prescription opioid medications has quadrupled since 1999. Not only are the patients who receive the prescription at risk, with 5-20% remaining dependent for months following surgical procedures, but these prescriptions introduce excess opioids into the community, leading to increasing diversion. This makes practices in postoperative opioid prescription and patient counseling, for which there are no widely accepted guidelines, a critical element in managing the opioid epidemic.
Methods:
A retrospective chart review was conducted of all patients who underwent uncomplicated outpatient laparoscopic cholecystectomy between January 2015 – July 2016 at a large academic medical center. Initial postoperative opioid prescriptions were examined for prescribing provider type and amount prescribed in oral morphine equivalents (OMEs). Written discharge instructions for each patient were also reviewed to identify those that contained specific instructions regarding typical use of opioids, risks of addiction, and use of non-opioid analgesics. Descriptive analysis was used to characterize opioid prescriptions and written discharge instructions.
Results:
A total of 123 patients underwent outpatient laparoscopic cholecystectomy during the study period. Mean age was 45±14 years and 78% of patients were female. All patients received a prescription for opioids and 92% were prescribed by surgical residents. Average total OME prescribed was 247±93 mg (approximately equivalent to 50 tablets of hydrocodone/acetaminophen 5/325) with a range of 60-600 mg (equivalent to 12-120 tablets of the same). Medications prescribed included hydrocodone/acetaminophen 5/325 (80%), oxycodone 5 mg (13%), oxycodone/acetaminophen 5/325 (5%), and tramadol (2%). Written discharge instructions also varied widely. Only 40% of patients received instructions regarding use of ibuprofen or acetaminophen, with 21% of instructions specifically recommending that patients start with these first, and only 7% stating that many patients find that opioids are not necessary at all. The risks of addiction were specifically discussed for only 33% of patients. No patients received written instructions regarding the risks of leftover medication or safe disposal.
Conclusion:
Postoperative opioid prescriptions and written patient instructions vary widely following a routine outpatient surgical procedure. Furthermore, patients are infrequently informed about non-opioid options for pain control and the risks of addiction. Given that postoperative opioid prescription plays a key role in patient safety and drug diversion, future efforts should be aimed at safe prescribing practices and providing patients with appropriate information.
