A. A. Mazurek1, A. A. Brescia1, R. Howard1, A. Schwartz1, K. Sloss1, A. Chang1, P. Carrott1, J. Lin1, W. Lynch1, M. Orringer1, R. Reddy1, P. Lagisetty2, J. Waljee1, M. Englesbe1, C. Brummett1, K. Lagisetty1 1University Of Michigan,Department Of Surgery,Ann Arbor, MI, USA 2Ann Arbor VA,Division Of General Internal Medicine And Center For Clinical Management And Research,Ann Arbor, MI, USA
Introduction: Recent studies have demonstrated a high prevalence of excessive opioid prescribing after surgery, and the incidence of persistent opioid use is among the highest after thoracic surgery. Procedure-specific prescribing guidelines have been shown to reduce excessive prescribing in certain health systems; however, this has not been studied within thoracic surgery. There is little data available to assess how many opioids patients take versus are prescribed following surgery. To establish evidence-based guidelines to reduce excessive prescribing, this study compared postoperative opioid prescribing dosages to actual usage following open and laparoscopic hiatal hernia repair (HHR).
Methods: Retrospective chart review was performed on 119 patients who underwent open (transthoracic and transabdominal) or laparoscopic HHR between January and December 2016, and received an opioid prescription after surgery. The patient cohort consisted of opioid naïve patients, defined as individuals not using opioids at the time of surgery. Patients underwent a telephone survey regarding postoperative opioid use. The amount of opioid prescribed was quantified in oral morphine equivalents (OME) to adjust for varying potencies between medications. Descriptive statistics (median and interquartile range, IQR) were used to summarize variables. Mann-Whitney U tests were used to compare the OME prescribed vs. actual patient use within the patient cohort.
Results: 91 opioid naïve patients (37 open HHR; 54 laparoscopic HHR) were surveyed, with a response rate of 69% (n=63, 27 open, 36 lap). Mean age was 59 ± 14 years and the cohort was 65% female. Median follow-up time was 305 days (IQR 209-463). The overall median prescription size was 300 mg OME (IQR 225-375) and median patient use was 150 mg OME (IQR 25-300) (p<0.0001). Following open HHR, median prescription size was 350 mg OME (IQR 250-420) and median patient use was 225 mg OME (IQR 105-300) (p=0.001). Following laparoscopic HHR, median prescription size was 270 mg OME (IQR 200-350) and median patient use was 106 mg OME (IQR 6-295) (p<0.0001). In comparing open vs. laparoscopic HHR, significantly more OME were prescribed for open (p=0.01), with a difference in median patient use that did not reach statistical significance (p=0.08).
Conclusion: Patients use far fewer opioids than they are prescribed following open and laparoscopic HHR. While there is excess prescribing in both cohorts, laparoscopic procedures tended to have a greater difference in amount prescribed versus actual usage. These findings may be used to develop guidelines that better standardize postoperative prescribing to reduce overprescribing.
