D. S. Swords1,2, S. Vijayakumar1, S. Brimhall1, B. Ostlund1, P. Narayanan1, J. Prochazka1, D. E. Skarda1,2 1Intermountain Healthcare,Surgical Services,Salt Lake City, UT, USA 2University Of Utah,Surgery,Salt Lake City, UT, USA
Introduction: Previous studies have found that surgeons commonly over-prescribe opioid pain medications to surgical patients, representing an opportunity to decrease the flow of unnecessary opioids into the community. However, few resources are available for surgeons regarding the quantity of opioid medications that patients actually require after various surgeries. The goals of this study were to assess prescribing practices of surgeons and patient opioid utilization after a wide variety of surgical procedures.
Methods: Between January 15 and August 21, 2017, patients who underwent surgical procedures at 1 of 27 Intermountain Healthcare (IHC) facilities were sent an email-based survey 2-3 weeks postoperatively. Surveys were re-sent to initial non-responders 2 additional times at 3 day intervals. The survey included questions about preoperative and postoperative opioid utilization. The IHC Enterprise Data Warehouse was queried for information about postoperative opioid prescriptions.
Results: During the study period, 6673/21434 (31.1%) patients responded to the survey. Sixty-nine percent of patients were opioid naïve, and 31.0% had taken opioids in the month prior to surgery. The cohort was comprised of 38.2% orthopedic surgery patients, 17.6% general surgery, 7.8% ENT, 7.2% gynecology, 7.3% urology , 4.9% neurosurgery, 4.9% plastics/maxillofacial and 12.1% other specialties. Narcotic naïve patients were prescribed a median of 30 pills (interquartile range [IQR] 24, 50), but used a median of only 4 (IQR 0, 15). Patients who had taken narcotics in the month prior to surgery were prescribed a median of 30 pills (IQR 24, 60) and also took a median of only 4 (IQR 0, 20). When examined on a procedure-specific basis, there was also substantial over-prescription of opioids for most examined procedures. Results for 5 representative procedures are shown in the Table.
Conclusion: The majority of patients undergoing surgery are substantially over-prescribed opioids postoperatively, representing a significant source of unnecessary opioids into the community. Surgeons have an opportunity to increase the appropriateness of postoperative opioid prescribing by prescribing patients fewer opioids. Our next step will be to provide our surgeons with recommendations regarding the number of doses that will satisfy the pain needs of the majority of patients.
