J. Hur1, J. S. Lee1, H. M. Hu1, M. P. Klueh1, R. A. Howard1, J. V. Vu1, C. M. Harbaugh1, C. M. Brummett2, M. J. Englesbe1, J. F. Waljee1 1University Of Michigan,Department Of Surgery,Ann Arbor, MI, USA 2University Of Michigan,Department Of Anesthesiology,Ann Arbor, MI, USA
Introduction:
Despite growing concerns about the dangers of prescription opioids, deaths from opioid overdoses have increased in recent years, reaching over 33,000 fatalities in 2015. Surgeons play a key role in this epidemic, providing 10% of opioid prescriptions in the United States. In this context, it is unclear how opioid prescribing by surgeons has changed during this time period. In this study, we examined trends in postoperative opioid prescription size over time. We hypothesized that postoperative opioid prescription size would increase during this time period.
Methods:
Using a nationwide dataset of employer-based insurance claims, we identified opioid-naive patients who underwent laparoscopic cholecystectomy, breast procedures (lumpectomy and mastectomy), or wide local excision from 2010 – 2014. Opioid prescriptions were obtained from pharmacy claims and converted to oral morphine equivalents (OMEs) for comparison. Our primary outcome measure was the size of the first opioid prescription between the day of surgery and 14 days after discharge. We calculated the mean prescription size with 95% confidence intervals for each year and procedure type. Mean prescription sizes were compared using t-tests.
Results:
In this cohort, 134,085 opioid-naïve patients underwent surgery during the study period. Of these patients, 108,893 (81.2%) underwent laparoscopic cholecystectomy (mean age 46 ± 15 years; 71.1% female); 19,199 (14.3%) underwent breast procedures (mean age 58 ± 12 years, 99.8% female); and 5,993 (4.5%) underwent wide local excision (mean age 55 ± 14 years, 45.1% female). Figure 1 shows the mean opioid prescription size by year and procedure type. For laparoscopic cholecystectomy, opioid prescriptions markedly increased in size from 230 OMEs in 2010 (equivalent to 46 tablets of 5 mg hydrocodone) to 475 OMEs in 2014 (equivalent to 95 tablets of 5 mg hydrocodone). This increase was statistically significant (p<0.001). Prescription size for breast procedures also increased significantly from 228 OMEs to 394 OMEs (p<0.001). For wide local excision, prescription size increased from 200 OMEs to 277 OMEs, but this difference was not statistically significant (p=0.10).
Conclusion:
For opioid-naïve patients undergoing common elective surgical procedures, opioid prescription size continued to increase from 2010 – 2014, reaching the equivalent of almost 100 tablets of 5 mg hydrocodone in 2014. Given recent studies showing most surgical patients require only 10 – 15 tablets of 5 mg hydrocodone, surgeons should focus on tailoring opioid prescriptions to better match actual patient requirements.
