J. Zhao1,2, L. E. Peters1,2, S. DiSano1, G. S. Zhang1, H. Pearce1, S. R. Smith1,2,3, P. Pockney1,2,3 1John Hunter Hospital,Department Of Surgery,New Lambton Heights, NSW, Australia 2University of Newcastle,School Of Medicine And Public Health,Callaghan, NSW, Australia 3Hunter Medical Research Institute,New Lambton Heights, NSW, Australia
Introduction:
Opioid analgesics are frequently used for the management of postoperative pain. In the last 20 years there has been a 4-fold increase in the prescription rates worldwide, with Australian data also demonstrating a 3-fold increase. Thirty-six percent of all opioids prescribed have been attributed to a postoperative script, with 8% of opioid-related deaths ascribed to a surgeon’s script pad. American literature demonstrates up to 92% of general surgical patients are discharged with opioids, with between 42-71% going unused. We present the first substantial Australian analysis of this issue.
Methods:
We are prospectively recruiting consecutive patients undergoing laparoscopic appendicectomy, laparoscopic cholecyctectomy, laparoscopic or open inguinal hernia repair, thyroidectomy, elective colorectal resections, and restoration of bowel continuity procedures, in two public teaching hospitals in Newcastle, Australia. Patients are contacted 7-10 days after discharge and asked to participate in a phone survey regarding their analgesic use.
Results:
Since March 2019, 372 of 440 eligible patients (85%) completed the survey. One hundred and forty-three patients (38.4%) were provided opioid analgesics of which 58.5% went unused. Of those who did receive opioids, the median amount provided was the equivalent of 40mg of oxycodone (range 10-100mg oxycodone), with the median amount consumed was 25mg of oxycodone (or equivalent). Forty-eight patients (12.9%) sought opioids from sources outside the hospital.
Conclusion:
Despite lower rates of opioid prescriptions in Australia after general surgical procedures, more than half of the opioids provided remained unused. Recruitment for our study is ongoing at a rate of approximately 100 per month, with analysis instep with recruitment. This will allow a comprehensive further examination of post-discharge opioid requirements, rates of unused opioids, opioid prescribing habits of junior doctors, prescriber variability, and adequacy of junior doctor training in opioid prescribing.