Prescribing Recommendations

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.

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Updated February 25, 2020

Procedure Oxycodone* 5mg Tablets
Dental Extraction 0
Thyroidectomy 0 - 5
Laparoscopic Anti-reflux (Nissen) 0 - 10
Appendectomy – Lap or Open 0 - 10
Laparoscopic Donor Nephrectomy 0 - 10
Hernia Repair – Minor or Major 0 - 10
Sleeve Gastrectomy 0 - 10
Laparoscopic Cholecystectomy 0 - 10
Open Cholecystectomy 0 - 15
Laparoscopic Colectomy 0 - 10
Open Colectomy 0 - 15
Ileostomy/Colostomy Creation, Re-siting, or Closure 0 - 15
Open Small Bowel Resection or Enterolysis 0 - 15
Prostatectomy 0 - 10
Carotid Endarterectomy 0 - 10
Cardiac Surgery via Median Sternotomy 0 - 25
Caesarean Section 0 - 20
Hysterectomy – Laparoscopic or Vaginal 0 - 15
Hysterectomy – Abdominal 0 - 20
Breast Biopsy or Lumpectomy 0 - 5
Lumpectomy + Sentinel Lymph Node Biopsy 0 - 5
Sentinel Lymph Node Biopsy Only 0 - 5
Wide Local Excision ± Sentinel Lymph Node Biopsy 0 - 20
Simple Mastectomy ± Sentinel Lymph Node Biopsy 0 - 20
Modified Radical Mastectomy or Axillary Lymph Node Dissection 0 - 30
Total Hip Arthroplasty 0 - 30
Total Knee Arthroplasty 0 - 50

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

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Pediatric Prescribing Recommendations

These recommendations are for patients under 18 years of age.

Procedure Doses
Adenoidectomy 0
Appendectomy 0
Circumcision* 0-5
Dental Extraction 0
Inguinal Hernia 0
Orchiopexy 0-5
Supracondylar Humerus Fracture 0-5
Umbilical Hernia 0

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

Download Pediatric Prescribing Recommendations

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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.