Z. Sanford1, A. Broda1, A. Weltz1, I. Belyansky1 1Anne Arundel Medical Center,Department Of Surgery,Annapolis, MD, USA
Introduction:
Unintentional poisoning has become the leading cause of injury-related fatalities in the United States and many of these are directly from prescription opioids. A lack of guidelines for opioid prescription in surgical management may lead to variations in amount of medication prescribed to patients.
Methods:
A retrospective review focusing on differences in prescribing habits of surgeons as a function of case frequency was performed for all patients undergoing laparoscopic cholecystectomy and laparoscopic inguinal hernia repair from January 2014 to June 2017. Inpatient medication was adjusted to Morphine Milligram Equivalents (MME).
Results:
In a cohort of twenty-two surgeons, twenty-two performed laparoscopic cholecystectomy and ten performed laparoscopic inguinal hernia repair. Patients undergoing laparoscopic cholecystectomy (n = 1,890) presented with a mean age, BMI, and ASA score of 50.9 years, 31.4 kg/m2, and 2.3, respectively, with a procedure time of 57.0 minutes, hospital LOS of 2.2 days, and opioid pain prescription of 12.6 MME per day. 14.5% of patients did not receive any opioid pain control and daily prescribed doses ranged from 0-521.1 MME. Patients undergoing laparoscopic inguinal hernia repair (n = 821) presented with a mean age, BMI, and ASA score of 57.0 years, 27.0 kg/m2, and 2.1, respectively, with a procedure time of 61.6 minutes, hospital LOS of 1.1 days, and opioid pain control of 6.6 MME per day. 30.8% of patients did not receive any opioid pain control and daily prescribed doses ranged from 0-91.4 MME. In both the laparoscopic cholecystectomy (p < 0.0001) and laparoscopic inguinal hernia repair (p < 0.0064) subgroups surgeons demonstrated consistent prescription patterns individually within their own practice however there were significant differences among inter-surgeon prescribing patterns of postoperative opioid pain control.
Conclusion:
Prescribing habits of MME are based solely on personal preference and the professional discretion of prescribing physicians resulting in significant inter-surgeon variability in daily-prescribed MME after laparoscopic cholecystectomy and laparoscopic inguinal hernia.