Vu JV, Cron DC, Lee JS, et al. Classifying Preoperative Opioid Use for Surgical Care. Ann Surg. 2020;271(6):1080-1086. doi:10.1097/SLA.0000000000003109
- Preoperative opioid use is common among patients who undergo elective surgery, with 38% filling an opioid prescription in the 12 months before surgery.
- Even minimal opioid use before surgery increases the probability of needing additional postoperative prescriptions in the 30 days after surgery.
- Surgeons should take into account any preoperative opioid use in patients when prescribing and coordinating postoperative pain management.
Howard R, Alameddine M, Klueh M, et al. Spillover Effect of Evidence-Based Postoperative Opioid Prescribing [published correction appears in J Am Coll Surg. 2019 Apr;228(4):720]. J Am Coll Surg. 2018;227(3):374-381. doi:10.1016/j.jamcollsurg.2018.06.007
- After introducing evidence-based prescribing recommendations for laparoscopic cholecystectomy, prescribing decreased for four other surgical procedures, with no significant increase in refill requests.
- Implementing evidence-based prescribing recommendations contributes to increased awareness of safe and appropriate opioid prescribing practices.
Howard R, Fry B, Gunaseelan V, et al. Association of Opioid Prescribing With Opioid Consumption After Surgery in Michigan. JAMA Surg. 2019;154(1):e184234. doi:10.1001/jamasurg.2018.4234
- The quantity of opioid prescribed is associated with higher patient-reported opioid consumption, with patients using .5 more pills for every additional pill prescribed.
- The use of patient-reported opioid consumption to improve prescribing practices is key to combating the opioid epidemic.
Bennett KG, Harbaugh CM, Hu HM, et al. Persistent Opioid Use Among Children, Adolescents, and Young Adults After Common Cleft Operations. J Craniofac Surg. 2018;29(7):1697-1701. doi:10.1097/SCS.0000000000004762
- 4% of patients who undergo cleft-related surgery continue using opioids following surgery, compared with 0.1% of nonsurgical patients.
- Patients undergoing distractor placement have higher rates of opioid use three months after surgery.
- New persistent opioid use occurs after cleft-related procedures and can lead to chronic use in children, adolescents, and young adults.
Cron DC, Hwang C, Hu HM, et al. A statewide comparison of opioid prescribing in teaching versus nonteaching hospitals. Surgery. 2019;165(4):825-831. doi:10.1016/j.surg.2018.10.005
- In Michigan, surgical patients discharged from teaching hospitals fill significantly larger opioid prescriptions and have higher rates of high-risk prescribing compared with patients discharged from nonteaching hospitals.
- All hospitals, particularly teaching hospitals, should devote adequate resources to facilitating safe postoperative opioid prescribing.
Cron DC, Lee JS, Dupree JM, et al. Provider Characteristics Associated With Outpatient Opioid Prescribing After Surgery. Ann Surg. 2020;271(4):680-685. doi:10.1097/SLA.0000000000003013
- Advanced practice providers account for 1-in-5 postoperative opioid prescriptions.
- Postoperative opioid prescriptions written by advanced practice providers are 18% larger than those written by physicians.
- All providers should be involved in postoperative care to understand prescribing practices and identify barriers to reducing prescribing.
Habbouche J, Lee J, Steiger R, et al. Association of Hydrocodone Schedule Change With Opioid Prescriptions Following Surgery [published correction appears in JAMA Surg. 2018 Dec 1;153(12):1164]. JAMA Surg. 2018;153(12):1111-1119. doi:10.1001/jamasurg.2018.2651
- After hydrocodone was changed from a schedule III to schedule II controlled substance, the mean OMEs filled in the initial opioid prescription increased by approximately 35 OMEs, equivalent to 7 tablets of hydrocodone.
- Opioid-related policies, and any subsequent edits, must be closely monitored to identify unintended effects.
Brescia AA, Harrington CA, Mazurek AA, et al. Factors Associated With New Persistent Opioid Usage After Lung Resection. Ann Thorac Surg. 2019;107(2):363-368. doi:10.1016/j.athoracsur.2018.08.057
- 14% of opioid-naive patients continue to fill opioid prescriptions in the 3 to 6 months after lung resection.
- Adjuvant therapy and thoracotomy are the greatest risk factors for persistent opioid use following lung resection.
- Future studies should focus on reducing excess prescribing, perioperative patient education, and safe opioid disposal.
Larach DB, Waljee JF, Hu HM, et al. Patterns of Initial Opioid Prescribing to Opioid-Naive Patients. Ann Surg. 2020;271(2):290-295. doi:10.1097/SLA.0000000000002969
- The proportion of initial prescriptions for surgery, emergency, and dental care increased by nearly 16% from 2010 to 2016.
- Dental care prescribing saw the greatest growth, with a 68% increase, while surgical patients received the highest proportion of potent opioids (90.2%).
- Evidence-based guidelines for surgical and dental prescribing are necessary to curb iatrogenic opioid morbidity and mortality.
Harbaugh CM, Nalliah RP, Hu HM, Englesbe MJ, Waljee JF, Brummett CM. Persistent Opioid Use After Wisdom Tooth Extraction. JAMA. 2018;320(5):504-506. doi:10.1001/jama.2018.9023
- Approximately 80% of patients who were not using opioids before wisdom tooth extraction filled an opioid prescription at the time of surgery.
- Opioid prescriptions at the time of wisdom tooth extraction lead to a 3-fold increased odds of developing persistent opioid use in the year after surgery among adolescents and young adults.
- Given the effectiveness of non-opioid analgesics, the practice of any routine opioid prescribing must be questioned in the face of the potential morbidity and long-term consequences of opioid use.