Common Surgical Procedures Account for High Share of Opioid Prescriptions in Children and Adults

A small number of the most common surgical procedures comprise a large share of all opioids prescribed following a surgery in adults and children, according to studies published in JAMA Network Open and Pediatrics.^1,2

Image credit: Tom Nevesely | stock.adobe.com

In adults, common surgical procedures like cesarean delivery, laparoscopic cholecystectomy, and orthopedic procedures accounted for most morphine milligram equivalents (MMEs) and opioid prescriptions dispensed to patients after surgery.¹

In children (0 to 11 years), the procedures that made up the highest share of opioid prescriptions were tonsillectomy and/or adenoidectomy, removal of deep implants, and open treatment of upper extremity fracture. For patients aged 12 to 21 years, the top procedures were tonsillectomy and/or adenoidectomy, knee arthroscopy, and cesarean delivery.²

"Our findings suggest that surgical opioid prescribing is highly concentrated among a small group of procedures. Efforts to ensure safe and appropriate surgical opioid prescribing should focus on these procedures," Kao-Ping Chua, lead author of the study in Pediatrics and an assistant professor of the U-M Medical School and School of Public Health said in a news release.³

A national growth in opioid prescribing rates has coincided with a dramatic rise in opioid-related overdose deaths, and prior literature has indicated a link between opioid prescription for postoperative pain relief and opioid-related adverse events, including misuse and overdose.¹

In the JAMA Network Open analysis, the investigators conducted a national study of prescriptions following surgical procedures among privately and publicly insured non-elderly adults. They assessed the procedures that accounted for the highest dose, frequency, and refills for postoperative opioid prescriptions, which they noted “could help direct limited resources for surgical opioid stewardship toward targets that will provide the greatest value.”¹

The total sample of surgical episodes was 1,040,934. Among these procedures, 503,058 of the total number of surgical episodes (48.3%) were associated with a dispensed opioid prescription, with the number of unique patients with a prescription being 480,757 out of 917,351 total patients.¹

For those aged 18 to 44 years, cesarean delivery accounted for 19.4% (11,418,658) of 58,825,364 total MMEs, followed by hysterectomy (6.8% [3,971,371 MMEs]) and knee arthroscopy (6.3% [3,681,759 MMEs]). For those aged 45 to 64 years, 4 of the top 5 procedures were orthopedic procedures, accounting for 27.4% of the total MMEs dispensed to those in that age group.¹

Dispensed opioid prescriptions in individuals aged 18 to 44 were highest after cesarean delivery, which represented 22.2% of all prescriptions (56,353 of 253,403) and was nearly triple that of the next highest procedure, which was hysterectomy (8.0% [20,348 prescriptions]). Interestingly, laparoscopic cholecystectomy had the highest individual rate of dispensed prescriptions at 75.2% (18,449 of 24,523 procedures).¹

In the Pediatrics study, the investigators formulated an algorithm to identify 1082 major surgical procedures using procedure codes, which are a medical classification tool used to identify specific surgical, medical, or diagnostic interventions – similarly to the previously mentioned study analyzing adult patients. This was then applied to identify privately and publicly insured children.³

There was a total of 107,597 procedures for patients aged 0 to 11 years. The top 3 procedures accounted for 59.1% of MMEs in opioid prescriptions that were dispensed following surgery: tonsillectomy and/or adenoidectomy (50.3%), open treatment of upper extremity fracture (5.3%), and removal of deep implants (3.5%), according to the investigators.²

For patients aged 12 to 21 years, the top 3 procedures accounted for 33.1% of all MMEs, and they were tonsillectomy and/or adenoidectomy (12.7%), knee arthroscopy (12.6%), and cesarean delivery (7.8%).² Cesarean delivery was a top procedure for which MMEs were prescribed afterwards for both adult and pediatric patients, emphasizing the need for better management of patient treatment protocols to ensure there are no opioid-related adverse events for patients.

“Our findings suggest that there are important opportunities to reduce surgical opioid prescribing without compromising pain control,” Dominic Alessio-Bilowus, lead author of the adult-focused study published in JAMA Network Open, said in a news release.³

References

1. Alessio-Bilowus D, Chua K, Peahl A, et al. Epidemoiology of opioid prescribing after discharge from surgical procedures among adults. JAMA Netw Open. 2024;7(6):e2417651. doi:10.1001/jamanetworkopen.2024.17651

2. Chua K, Brummett C, Kelly-Quon L, et al. Pediatric surgical opioid prescribing by procedure, 2020-2021. Pediatrics. 2024;154(1):e2024065814. doi:10.1542/peds.2024-065814

3. Barnes K. A few surgical procedures account for high number of opioid prescriptions. EurekAlert! News release. Released June 28, 2024. Accessed July 11, 2024. https://www.eurekalert.org/news-releases/1049878