Prescribing Recommendations (Old)

Excessive prescribing of opioids after surgery places patients at risk of becoming new persistent users, a significant surgical complication. Among opioid-naïve patients undergoing common surgical procedures, 6-10% continue filling opioid prescriptions 3-6 months after surgery.1,2 72% of opioids prescribed by surgeons go unused by patients. 3

These procedure-specific prescribing recommendations were developed by Michigan OPEN to curb this over-prescribing of post-operative opioids. These recommendations, for patients with no preoperative opioid use, were informed by patient-reported data from our Collaborative Quality Initiative (CQI) partners, published studies and expert opinion.  For patients taking opioids preoperatively, prescribers are encouraged to use their best judgment.

As part of post-operative pain care, Michigan OPEN strongly advocates patient counseling prior to surgery, and the use of over-the-counter medications, when indicated.

These recommendations will be revised as new data becomes available. Subscribe to be notified by email when the recommendations are updated.

Note: All procedure links open in a new window.

Updated February 25, 2020

*If prescribing hydrocodone 5mg, the number of tablets remains the same as listed above.

Pediatric Prescribing Recommendations

These recommendations are for patients 18 years of age and under.

Adenoidectomy 0
Appendectomy 0
Dental Extraction 0
Inguinal Hernia 0
Umbilical Hernia 0

*Consider 0 doses for children ≤ 5 y.o.

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1. Hill M, McMahon ML, Stucke RS, Barth RJ Jr. Wide variation and excessive dosage of opioid prescriptions for common general surgical procedures. Ann Surg. 2017;265(4):709-714.

2. Bicket MC, Long JJ, Pronovost PJ, Alexander GC, Wu CL. Prescription opioid analgesics commonly unused after surgery: A systematic review. JAMA Surg. 2017;152(11):1066-1071.

3. 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.