K. A. Robinson1, J. D. Phillips2, D. Agniel3, I. Kohane3, N. Palmer3, G. A. Brat1,3 1Beth Israel Deaconess Medical Center,Surgery,Boston, MA, USA 2Dartmouth-Hitchcock,Thoracic Surgery,Lebanon, NH, USA 3Harvard Medical School,Biomedical Informatics,Boston, MA, USA
Introduction:
The US is facing an opioid epidemic with an increasing number of abuse, misuse and overdose events. As a major group of prescribers, surgeons must understand the impact that post-surgical opioids have on the long-term outcome of their patients. Previous work has demonstrated that approximately 6% of opioid naïve patients have new persistent opioid use postoperatively (Brummett et al., 2017). In thoracic surgery, postoperative pain has been a significant determinant of morbidity. It is generally accepted that video assisted or minimally invasive approaches allow patients to recover faster and with less postoperative pain. However, recent literature has been unable to show a significant difference in chronic pain after minimally invasive versus open thoracotomy (Brennan & Ph, 2017). In this study, we aimed to identify if there was a difference in postoperative opioid prescribing in patients undergoing minimally invasive compared to open thoracic surgery.
Methods:
In a de-identified administrative and pharmacy database of over 1.4 million opioid naïve surgical patients for the years 2008-2014, we retrospectively analyzed patients undergoing minimally invasive thoracic surgery vs open thoracic surgery based upon their ICD coding and compared these cohorts with opioid prescribing and post-operative misuse codes.
Results:
1907 minimally invasive (MIS) and 2081 open thoracic surgery cases were identified from CPT cohorts. During the years of the study, average daily morphine milligram equivalents prescribed decreased for both open and MIS thoracic cases (Figure 1a). However, during this same time period, the duration of opioids prescribed after minimally invasive thoracic did not significantly change. In fact, duration of prescription was trending toward an increased duration for both open thoracic surgery and MIS thoracic surgery (Figure 1b).
Conclusion:
Previous work has demonstrated that increasing the duration of opioid prescribed after surgery is a stronger predictor of opioid misuse than dosage prescribed. By prolonging the length of exposure to opioid medications, prescribers may not be reducing the risk of misuse in their patients. Furthermore, we observed that open and MIS patients were prescribed approximately the same daily dose. This suggests that postoperative prescribing behavior for pain is not defined by the surgery performed.
