Vu JV, Lin LA. Opioid Overdose-the Surgeon's Role. Ann Surg. 2018;268(1):32-34. doi:10.1097/SLA.0000000000002713
- It is crucial for surgeons to perform a series of preoperative assessments (check for history of substance abuse, previous overdose, past opioid prescriptions, comorbid conditions, etc.) in order to identify patients with an increased risk of opioid overdose.
- More surgeon involvement in research, evidence-based practice, and education will help to combat opioid misuse and overdose after surgery.
Waljee JF, Cron DC, Steiger RM, Zhong L, Englesbe MJ, Brummett CM. Effect of Preoperative Opioid Exposure on Healthcare Utilization and Expenditures Following Elective Abdominal Surgery. Ann Surg. 2017;265(4):715-721. doi:10.1097/SLA.0000000000002117
- Preoperative opioid use is an independent risk factor for longer hospital stays, higher 30-day readmission rates, higher probability of being discharged to a rehabilitation facility, and greater healthcare expenses in the postoperative period.
- Identifying strategies to minimize opioid consumption prior to surgery will aid in reducing patient risk, improving outcomes, and lowering healthcare costs.
Klueh MP, Hu HM, Howard RA, et al. Transitions of Care for Postoperative Opioid Prescribing in Previously Opioid-Naïve Patients in the USA: a Retrospective Review. J Gen Intern Med. 2018;33(10):1685-1691.
- Among surgical patients who developed new persistent opioid use, surgeons provided the majority of opioid prescriptions during the first three months after surgery.
- By nine to twelve months after surgery, however, the majority of opioid prescriptions were provided by primary care physicians.
- Enhanced care coordination between surgeons and primary care physicians could allow earlier identification of patients at risk for new persistent opioid use to prevent misuse and dependence.
Cron DC, Englesbe MJ, Bolton CJ, et al. Preoperative Opioid Use is Independently Associated With Increased Costs and Worse Outcomes After Major Abdominal Surgery. Ann Surg. 2017;265(4):695-701. doi:10.1097/SLA.0000000000001901
- The study considered patients at a single center having abdominopelvic surgeries (appendectomy, cholecystectomy, gynecologic and bowel procedures, etc.) and found that patients using opioids preoperatively had 9.2% higher costs.
- Patients with preoperative opioid use had longer length of stay at the hospital, more complications and more readmissions, indicating that preoperative opioid use is a modifiable risk factor for surgery.
Sekhri S, Arora NS, Cottrell H, et al. Probability of Opioid Prescription Refilling After Surgery: Does Initial Prescription Dose Matter?. Ann Surg. 2018;268(2):271-276. doi:10.1097/SLA.0000000000002308
- Approximately 9% of patients who were not using opioids preoperatively refilled an opioid prescription after surgery.
- The probability of a patient refilling a postoperative opioid prescription was not correlated with their initial prescription strength.
- Surgeons could prescribe smaller opioid prescriptions without influencing the probability of a refill request.
Lee JS, Hu HM, Brummett CM, et al. Postoperative Opioid Prescribing and the Pain Scores on Hospital Consumer Assessment of Healthcare Providers and Systems Survey. JAMA. 2017;317(19):2013-2015. doi:10.1001/jama.2017.2827
- The Center for Medicare & Medicaid Services’ Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) captures key elements of patient satisfaction, including pain management. The study found no correlation between HCAHPS pain measures and postoperative opioid prescribing in surgical patients in Michigan.
- Clinicians can feel empowered to reduce their initial opioid prescription without harming patient satisfaction or their hospitals’ reimbursement.
Howard R, Waljee J, Brummett C, Englesbe M, Lee J. Reduction in Opioid Prescribing Through Evidence-Based Prescribing Guidelines. JAMA Surg. 2018;153(3):285-287. doi:10.1001/jamasurg.2017.4436
- Prior to the intervention, post-laparoscopic cholecystectomy (gall bladder removal surgery) opioid prescribing exceeded patient pain management needs by approximately 88%, based on patient- reported opioid use.
- Implementation of evidence-based prescribing guidelines reduced post-laparoscopic cholecystectomy opioid prescribing by 63% without increasing the need for medication refills.
- Patients who received smaller opioid prescriptions after the intervention reported using fewer opioids, indicating that anchoring and adjustment heuristics may impact patient opioid use.
Lee JS, Hu HM, Edelman AL, et al. New Persistent Opioid Use Among Patients With Cancer After Curative-Intent Surgery. J Clin Oncol. 2017;35(36):4042-4049. doi:10.1200/JCO.2017.74.1363
- 4% of cancer patients not on opioids prior to a curative-intent surgery fill prescriptions at daily doses similar to chronic opioid users one year after surgery.
- New persistent opioid use in patients receiving adjuvant chemotherapy is consistently higher than in those with no chemotherapy across different procedures.
- Changing prescribing guidelines and patient counseling in the surveillance and survivorship phases of care may reduce new persistent opioid use among cancer patients after surgery.
Harbaugh CM, Lee JS, Hu HM, et al. Persistent Opioid Use Among Pediatric Patients After Surgery. Pediatrics. 2018;141(1):e20172439. doi:10.1542/peds.2017-2439
- Rates of new persistent opioid use among pediatric patients are comparable to those for adults, with 4.8% of patients refilling opioid prescriptions between 3 and 6 months after surgery.
- Risk factors for new persistent opioid use include type of surgical procedure and patient traits such as older age, female sex, previous substance use disorder, chronic pain, and preoperative opioid fill.
- Understanding the risks contributing to new persistent opioid use among adolescents and young adults may help clinicians to minimize opioid exposure and reduce risk for later misuse.
Brummett CM, Waljee JF, Goesling J, et al. New Persistent Opioid Use After Minor and Major Surgical Procedures in US Adults. JAMA Surg. 2017;152(6):e170504. doi:10.1001/jamasurg.2017.0504
- New persistent opioid use after surgery is common, with approximately 6% of patients who were not on opioids before surgery continuing to use opioids more than 3 months after surgery.
- Patients continue to use their opioids for reasons other than the pain from surgery.
- New persistent opioid use after surgery is an underappreciated surgical complication that warrants increased attention.