A. Berezovsky2, P. Castaneda2, B. Cleary2, N. Osborne1, D. Coleman1 1University Of Michigan,Vascular Surgery,Ann Arbor, MI, USA 2University Of Michigan,Medical School,Ann Arbor, MI, USA
Introduction: The opioid epidemic has gained increasing visibility especially within surgery. Several surgical specialties have been analyzed for their postoperative opioid prescription patterns; however, vascular surgery prescribing practices have yet to be widely studied. Initial survey data from vascular surgery providers at an academic center reveal variable opioid prescribing patterns. This study examines vascular surgery prescribing patterns following Trivex Powered Phlebectomy (TPP) and Carotid Endarterectomy (CEA) procedures and compares these patterns with patient-reported opioid need.
Methods: A retrospective chart review examining CEA (May 2016-Jun 2017) and TPP (Jan 2016-Jun 2017) procedures was performed. Patient characteristics, chronic pain risk factors, comorbidities, and case complexity (only analyzed for TPP) were collected. Postoperative opioid prescriptions were recorded. A tri-state database of narcotic prescriptions was used to collect filling data. Phone surveys were conducted for patients who underwent CEA or TPP in this timeframe, assessing postoperative pain medication need and opioid use. Bivariate statistics were used to examine factors associated with opioid prescription filling and STATA was used to determine if risk factors, comorbidities, and case complexity were associated with prescription filling.
Results: 70 patients (61.4% male; mean age 68.3 (9.4)) underwent a total of 72 CEAs. 47 patients (67.1%) carried a diagnosis of at least one predisposing factor to pain. Postoperative opioids were prescribed after 54 procedures (75.0%). Of these prescriptions, 35 (64.8%) were filled. Mean prescribed oral morphine equivalent (OME) for filled prescriptions was 200.6mg (140.1) (median = 150mg); notably 100 OME is equivalent to 20 tablets Hydrocodone-acetaminophen 5-325. 56 patients completed phone survey on postoperative opioid need (response rate 80.0%). Of these patients, 38 (67.9) reported taking half or less than half the number of pills prescribed or no pills at all.
212 patients (34.4% male, mean age 52.2 (12.7)) underwent a total of 222 TPPs. 121 patients (57.1%) had a prior diagnosis of a predisposing factor to pain. Postoperative opioids were prescribed after 198 procedures (89.2%). Of these prescriptions, 169 (85.4%) were filled. Mean OME for filled prescriptions was 121mg (139.8) (median= 100mg). 88 TPP patients (response rate 41.5%) completed phone survey. 46 (52.3%) reported taking half or less than half the number of pills prescribed or no pills.
Conclusion: This preliminary data is a step towards understanding opioid prescribing patterns and patient filling habits following common vascular procedures. In these populations, not all patients filled their prescriptions; and those who did frequently did not require as many pills as provided. Further research is needed to identify factors predictive for opioid needs and use, and guide ‘best-prescription practices’ following vascular surgery procedures.