Opioid Prescribing Behavior after Elective Surgery Varies Widely

By Anne Harding

NEW YORK (Reuters Health) – Surgeons’ opioid prescribing practices vary widely, and overprescribing is common, new research suggests.

“We would encourage institutions or individual providers to review their own prescribing data and try to identify opportunities for improvement,” Dr. Elizabeth Habermann of the Mayo Clinic in Rochester, Minnesota, one of the study’s authors, told Reuters Health by telephone.

The findings are based on data from the American College of Surgeons National Surgical Quality Improvement Program, for 2013 to 2015, on 7,651 patients who underwent one of 25 commonly performed elective procedures at the Mayo Clinic’s three academic medical centers.

_______________________________________________________
Related Content
Nationwide Opioid Recall
Oversupply of Opioids After Surgery Helps Fuel Opioid Epidemic
_______________________________________________________

Currently, there are no evidence-based guidelines on prescribing opioids after surgery to outpatients, Dr. Habermann and her team note in their report, published online July 10 in the Annals of Surgery. The Centers for Disease Control and Prevention suggests that acute pain treatment with opioids be limited to fewer than seven days. Minnesota state guidelines suggest either seven days or no more than 200 oral morphine equivalents (OMEs). “There are guidelines, but whether they are evidence-based is up for discussion,” Habermann said.

The vast majority of the patients (93.9%) were prescribed opiates at discharge. The median prescription for opioid-naive patients was for 375 OMEs. More than 80% of prescriptions exceeded 200 OMEs.

Prescribing practice varied across the three centers and within each of the 25 procedures. Women were prescribed a higher average amount than men, and prescription size also increased with age.

“We saw a huge opportunity to standardize guidelines within our surgical practice to make sure a patient is treated similarly no matter who he or she sees,” Dr. Habermann said. She and her colleagues developed guidelines on opioid prescribing after orthopedic surgery that the Mayo Clinic recently adopted.

“We are continuing to work to identify what the optimal amount is and what over-prescription would even mean,” Dr. Habermann said. The 200-OME limit could lead to undertreatment of pain in many patients, she noted.

Dr. Habermann and her team are currently studying 2,500 surgical patients prescribed opiates, calling them a month after discharge to ask how many pills they have left, whether they felt the amount was adequate, and whether they refilled the prescription. “With those responses we’re going to be able to better infer what the right amount is to prescribe,” she said.

Surgeons are open to changing their prescribing practices, Habermann added. “They just have a number that they have traditionally prescribed, and they seem very open to evidence-based prescribing if we can give them data that are meaningful and will result in improved care of their patients,” she said.

SOURCE: https://bit.ly/2v4BHrs

Ann Surg 2017.

(c) Copyright Thomson Reuters 2017. Click For Restrictions - https://about.reuters.com/fulllegal.asp