R. Howard1, J. Lee1, J. Vu1, J. Waljee1, C. Brummett1, M. Englesbe1 1University Of Michigan,Ann Arbor, MI, USA
Introduction: Although recent studies show patients consume less than 30% of opioids prescribed after common surgical procedures, it is unknown how prescribing varies with the level of training of the prescriber. We hypothesized that opioid prescribing after laparoscopic cholecystectomy would vary significantly based on the level of the prescribing provider.
Methods: In this retrospective, single-center study, we identified patients undergoing elective laparoscopic cholecystectomy from 2015-2016. Postoperative opioid prescriptions represented in miligrams (mg) of oral morphine equivalents (OME) written at discharge were compared between surgical residents, faculty, and physician assistants (PAs). One-way ANOVA was used to evaluate the effect of provider level on the amount of opioid prescribed.
Results: A total of 170 patients were identified. All received postoperative opioid prescriptions at discharge. Surgical residents, faculty, and PAs prescribed 247.5±98.5 mg, 264.4±120.5 mg, and 357.1±180.7 mg, respectively (Figure 1), equivalent to 50, 53, and 71 tablets of hydrocodone/acetaminophen 5/325 mg. Provider level had a significant effect on opioid prescribing (p=0.03), which remains significant after controlling for chronic opioid use among patients (p=0.05). A Tukey post hoc test revealed that PAs prescribe significantly more opioids than residents (p=0.03).
Conclusion: Provider level has a substantial impact on opioid prescribing after laparoscopic cholecystectomy, with PAs prescribing significantly more compared to residents. As we develop evidence-based recommendations to standardize prescribing and reduce opioid excess after surgery, it will be crucial to communicate changes to all members of the surgical team.
