The number of opioid pills prescribed after surgery was the strongest predictor of the actual number of patients, with pain values and other factors being outweighed in a retrospective multicenter study.
On average, patients with general surgery used 27% of the opioids prescribed to them, but they used 5 for every 10 additional prescribed pills. Joceline Vu from the University of Michigan in Ann Arbor and colleagues JAMA Surgery.
"It's like ordering a large plate for dinner: you're probably going to eat more than if you had a small plate," Vu said MedPage today.
"Overall, we prescribe much, much more than patients consume," she added. "As surgeons, we often do not know how much of a prescription a patient uses, unlike a back pain remedy, we do not say," Take three of them per day. "We say, 'Here are 30 pills, take them when you need them.' We know that people are not taking all these pills, we know that some stay in patients' medicine cabinets."
Researchers reviewed data from 2,392 patients who had one of 12 surgical procedures in 2017 in 33 Michigan hospitals that belonged to the Michigan Surgical Quality Collaborative (MSQC). The patients were on average 55 years old and 57% were women; From 30 to 120 days after the operation, they carried out telephone or e-mail surveys.
The most frequent procedures were open and laparoscopic inguinal / femur hernia repair (28%), laparoscopic cholecystectomy (25%) and laparoscopic appendectomy (9%). Due to the small sample size, no vascular procedures were included in the analysis. The MSQC collected data on general surgery, vascular surgery and some gynecological procedures, but orthopedic surgery, neurosurgery, thoracic surgery and other procedures were not considered, Vu stated.
Overall, the prescribed amount of opioids averaged 150 oral morphine equivalents (OME), corresponding to 30 tablets hydrocodone / acetaminophen, 5/325 mg. The average number of patients receiving opioids was 45 OME or 9 tablets (P<0.001).
For each additional prescribed OME, patients additionally used 0.53 OME (95% CI 0.40 – 0.65; P<0.001). The amount of opioids prescribed had the strongest association with opioid use (standardized beta 0.565). Higher post-operative pain levels were also associated with increased opioid use, but to a lesser extent (standardized beta 0.184 for moderate pain, 0.217 for severe pain).
Compared to patients who reported no pain, mediocre patients reported an average of 9 more pills and patients reporting severe pain, 16 more pills (P<0.001). Tobacco use, the American Society of Anesthesiologists class, age, nature of the procedure and status of inpatient surgery were also tied to higher use.
"As surgeons, we want to tailor our prescribing to the needs of patients to ensure the best possible care while minimizing the risk of opioid redirection and abuse of downstream substances," said Gabriel Brat, MD, from the Beth Israel Deaconess Medical Center in Boston involved in the research.
"This study on general surgery and gynecology patients is an important complement to national efforts to capture and use patient-level opioid consumption data for this purpose," Brat said MedPage today. "We need this kind of work to quantify where over-prescribing prevails in all operations and to identify personalized levers for change, "
The research has several limitations, noted Vu and co-authors. Since it is based on observational data, it does not show causality. Data on preoperative opioid use were not available and could have influenced the results. The memory of patients about how many pills they used may not be accurate.
The analysis was completed before a new law was passed in Michigan this year prohibiting physicians from prescribing more than 7-day opioid care for patients with acute pain.
The study was funded by the Michigan Department of Health and Human Services and the National Institutes of Health. The researchers reported no conflicts of interest.
2018-11-07T15: 30: 00-0500