J. S. Danobeitia1, J. R. Imbus1, J. L. Philip1, D. F. Schneider1, D. Melnick1 1University Of Wisconsin,Surgery,Madison, WI, USA
Introduction:
Opioid prescription is a common practice following common general surgical operations. However, over-prescription is a major factor influencing opioid-related mortality. The objective of this study was to compare the general perceptions, beliefs and actual prescribing practices of general surgery physicians in an academic setting.
Methods:
We queried our electronic medical record to identify prescriptions written by physicians at our institution over a three-month period. We evaluated the quantity of pills prescribed after common ambulatory procedures: laparoscopic cholecystectomy (LC, n=62), laparoscopic inguinal hernia repair (LIHR, n=80), open umbilical hernia repair (UHR, n=42) and lumpectomy (LUMP, n=126). We also distributed a survey assessing education in pain evaluation and control, opioid prescription habits and expectation of pain in patients undergoing these operations. We compared prescriber perceptions to actual practices by estimating a perceived to prescribed pill ratio (P:P) for the management of post-operative pain.
Results:
A total of 58 surveys were completed by attending (43.1%) and resident (56.9%) physicians at our institution. Approximately 25% of respondents rated their education regarding pain evaluation/treatment during training as adequate while 22.0% considered it inadequate. Overall, the majority of respondents (72.2%) considered opioids necessary for post-operative pain management. When asked about appropriate duration of opioid treatment post-operatively, the most often selected duration was 3-5 days for LC (19.7%) and LIHR (18.8%). A longer duration (7-10 days) was more often selected for UHR (20.7%) and a shorter duration (1-3 days) was preferred for lumpectomies (28.9%). Further analysis revealed that the P:P ratio for attending physicians for LC and LIHR was higher (+34% each), while residents showed a +37% ratio for LUMP (Table 1). Participants cited procedure type (26%), history of chronic pain (23.8%), anticipated need for refills (17.7%) and patient age (16.6%) as the main variables driving pill quantity per prescription. Respondents reported discussing the details of each opioid prescription with senior residents and/or attending physicians less than half the time.
Conclusion:
The majority of physicians consider opioid medication necessary for management of post-operative pain, but only 25% rate their education regarding pain management as adequate. In addition, there appears to be a tangible discrepancy between provider beliefs and actual opioid prescribing practices. Implementation of educational programs and enhancing communication among care providers regarding best opioid prescription practices may constitute simple approaches to reduce narcotic over-prescription after surgery.
