Wide Variation and Overprescription of Opioids after Elective Surgery

Cornelius A. Thiels, Stephanie S. Anderson, Daniel S. Ubl, Kristine T. Hanson, Whitney J. Bergquist, Richard J. Gray, Halena M. Gazelka, Robert R. Cima, Elizabeth B Habermann

Research output: Contribution to journalArticle

71 Citations (Scopus)

Abstract

Objective: We aimed to identify opioid prescribing practices across surgical specialties and institutions. Background: In an effort to minimize the contribution of prescription narcotics to the nationwide opioid epidemic, reductions in postoperative opioid prescribing have been proposed. It has been suggested that a maximum of 7 days, or 200 mg oral morphine equivalents (OME), should be prescribed at discharge in opioid-naïve patients. Methods: Adults undergoing 25 common elective procedures from 2013 to 2015 were identified from American College of Surgeons National Surgical Quality Improvement Program data from 3 academic centers in Minnesota, Arizona, and Florida. Opioids prescribed at discharge were abstracted from pharmacy data and converted into OME. Wilcoxon Rank-Sum and Kruskal-Wallis tests assessed variations. Results: Of 7651 patients, 93.9% received opioid prescriptions at discharge. Of 7181 patients who received opioid prescriptions, a median of 375 OME (interquartile range 225-750) were prescribed. Median OME varied by sex (375 men vs 390 women, P = 0.002) and increased with age (375 age 18-39 to 425 age 80+, P < 0.001). Patients with obesity and patients with non-cancer diagnoses received more opioids (both P < 0.001). Subset analysis of the 5756 (75.2%) opioid-naïve patients showed the majority received >200 OME (80.9%). Significant variations in opioid prescribing practices were seen within each procedure and between the 3 medical centers. Conclusions: The majority of patients were overprescribed opioids. Significant prescribing variation exists that was not explained by patient factors. These data will guide practices to optimize opioid prescribing after surgery.

Original languageEnglish (US)
Pages (from-to)564-573
Number of pages10
JournalAnnals of Surgery
Volume266
Issue number4
DOIs
StatePublished - Oct 1 2017

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Opioid Analgesics
Morphine
Prescriptions
Surgical Specialties
Narcotics
Quality Improvement

Keywords

  • narcotic
  • opioid
  • postoperative pain
  • prescription
  • surgery

ASJC Scopus subject areas

  • Surgery

Cite this

Thiels, C. A., Anderson, S. S., Ubl, D. S., Hanson, K. T., Bergquist, W. J., Gray, R. J., ... Habermann, E. B. (2017). Wide Variation and Overprescription of Opioids after Elective Surgery. Annals of Surgery, 266(4), 564-573. https://doi.org/10.1097/SLA.0000000000002365

Wide Variation and Overprescription of Opioids after Elective Surgery. / Thiels, Cornelius A.; Anderson, Stephanie S.; Ubl, Daniel S.; Hanson, Kristine T.; Bergquist, Whitney J.; Gray, Richard J.; Gazelka, Halena M.; Cima, Robert R.; Habermann, Elizabeth B.

In: Annals of Surgery, Vol. 266, No. 4, 01.10.2017, p. 564-573.

Research output: Contribution to journalArticle

Thiels, CA, Anderson, SS, Ubl, DS, Hanson, KT, Bergquist, WJ, Gray, RJ, Gazelka, HM, Cima, RR & Habermann, EB 2017, 'Wide Variation and Overprescription of Opioids after Elective Surgery', Annals of Surgery, vol. 266, no. 4, pp. 564-573. https://doi.org/10.1097/SLA.0000000000002365
Thiels CA, Anderson SS, Ubl DS, Hanson KT, Bergquist WJ, Gray RJ et al. Wide Variation and Overprescription of Opioids after Elective Surgery. Annals of Surgery. 2017 Oct 1;266(4):564-573. https://doi.org/10.1097/SLA.0000000000002365
Thiels, Cornelius A. ; Anderson, Stephanie S. ; Ubl, Daniel S. ; Hanson, Kristine T. ; Bergquist, Whitney J. ; Gray, Richard J. ; Gazelka, Halena M. ; Cima, Robert R. ; Habermann, Elizabeth B. / Wide Variation and Overprescription of Opioids after Elective Surgery. In: Annals of Surgery. 2017 ; Vol. 266, No. 4. pp. 564-573.
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