A. Swarup1, K. A. Mathis1, M. V. Hill1, S. J. Ivatury1 1Dartmouth Medical School,General Surgery,Lebanon, NH, USA
Introduction:
Surgery for anorectal diseases is commonly thought to cause significant pain in the postoperative setting. There is little known regarding standardized opioid prescribing trends and patient use following surgery for anorectal disorders. With the ongoing opioid epidemic posing a significant health problem, we aimed to evaluate and analyze opioid prescribing trends and patient use for outpatient anorectal operations.
Methods:
All patients who underwent outpatient anorectal surgery performed over a one year period at a single institution were eligible. Procedures included hemorrhoidectomy, anal fistula repair/seton, anal fissure treatment with sphincterotomy, and transanal excision of rectal tumors. Demographic, operative and postoperative data was obtained. Patients were given a survey to determine postoperative pain control with opioid and non-narcotic analgesia use; respondents were included in analysis.
Results:
42 outpatient anorectal surgery patients were included: 13 had hemorrhoidectomy, 22 anal fistula repair/seton, 1 sphincterotomy and 6 transanal excisions. All patients had multimodality treatment with an anal block and postoperative Tylenol and/or ibuprofen. 90% were prescribed opioids postoperatively with a median of 20 pills (range: 0 – 120 pills). 43% (18/42) did not fill their prescription. For those who used opioids, the median number of pills taken was four. 80% of pills prescribed were not used. One patient required a refill. Greater than 60% of respondents reported good to excellent pain control on a five-point scale.
Conclusion:
There is large variability in the amount of opioids prescribed for patients undergoing outpatient anorectal surgery. When used with a multimodality pain treatment approach, opioids are minimally needed for most patients. We intend to standardize our prescribing opioid quantities for outpatient anorectal operations to reflect this reduced use.