Appropriate Post-Surgical Opioid Prescribing Examined

Findings from a new study published by JAMA Surgery sheds light on post-surgical opioid pain management to determine the appropriate prescription length.

Each day, many Americans die from an opioid overdose, as the opioid epidemic has become a significant public health crisis. Although overprescribing has been the main driver of the opioid epidemic, few guidelines exist to help physicians prescribe the drugs to manage pain without placing patients at a significant risk of addiction, according to the authors.

To determine optimal opioid practices, the authors analyzed prescribing patterns after surgeries, with appropriateness determined by the rate of refills.

Using data from the Military Health System Data Repository, the authors identified 215,140 patients aged 18 to 64 years who had undergone a common surgical procedure, including cholecystectomy, appendectomy, inguinal hernia repair, ACL reconstruction, rotator cuff tear repair, discectomy, mastectomy, and hysterectomy. Patients underwent surgery between 2006 and 2014 and were prescribed opioids.

The authors discovered that the median length for the first opioid prescription was 4 to 7 days. The duration of the prescription varied depending on the type of procedure conducted, with general surgery prescriptions averaging a 9-day prescription and musculoskeletal surgeries averaging 15 days, according to the study.

Depending on the type of surgery, the authors discovered the refill rate varied from 11.3% to 39.3%.

“While 7 days may be more than adequate for many patients undergoing common general surgery and gynecological procedures, prescription length limits may need to be extended to 10 days, recognizing that as many as 40% of patients may still require a refill at a 7-day limit for pain management, particularly following many orthopedic and neurosurgical procedures,” said first author Rebecca Scully, MD, MPH.

Using a mathematical model, the authors determined the optimal opioid prescription length was 4 to 9 days for general surgeries, while it was 4 to 13 days for women’s health procedures, according to the study. Musculoskeletal procedures required a lengthier opioid prescription, ranging from 6 to 15 days.

By identifying the appropriate length of post-surgery opioid treatment, the authors hope to curb the opioid epidemic and ensure that patients are being treated for pain, while not being put at risk of addiction.

“We recognize that the opiate crisis is being addressed on many social, legislative, and policy levels,” said senior author Louis Nguyen, MD, MBA, MPH. “We hope our paper provides a quantitative analysis of current prescribing patterns and sheds light on the optimal prescription in patients undergoing surgical procedures.”