Eddie Blay1, Michael J Nooromid2, Karl Y Bilimoria3, Jane L Holl4, Bruce Lambert5, Julie K Johnson3, Jonah J Stulberg3. 1. Surgical Outcomes and Quality Improvement Center, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. Electronic address: archimedes3t@gmail.com. 2. Division of Vascular Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. 3. Surgical Outcomes and Quality Improvement Center, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. 4. Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. 5. Department of Communication Studies, Northwestern University, Chicago, IL, USA.
Abstract
BACKGROUND: Surgeons play a pivotal role in the opioid epidemic but it is unknown how different members of a surgical team vary in the way they prescribe opioids after surgical episodes. STUDY DESIGN: We conducted a retrospective cohort study of all inpatient discharges for 5 common surgeries. Total number of tablets and total milligram equivalents (MME) prescribed were calculated and differences in prescription patterns were determined for attending surgeons, surgical residents and advanced practice providers. Using a generalized ordered logistic regression, we examined factors associated with ordering a higher number of tablets or MME. RESULTS: The median number of tablets (range) prescribed by rank were attending surgeon 30 (6-72), surgical resident 20 (6-189) and advanced care practitioner 40 (5-1000); p < 0.001.The median total MME prescribed by rank were attending surgeon 140 (30-600), surgical resident 200 (30-1600) and advanced practice provider 240 (25-1000); p < 0.001. There was no statistically significant difference by resident postgraduate year (PGY) for both total tablets and total MME prescribed. General surgery residents on average ordered a narrower range of total MME compared to surgical residents in other surgical specialties [20 (50-600) vs 20 (30-1600); p = 0.03]. On regression analysis, residents were less likely to order a higher number of tablets compared to attending surgeons (OR 0.29, p = 0.01). However, surgical residents and advanced care providers were more likely to prescribe a higher total MME compared to attending surgeons (OR 7.12, p < 0.001; OR 3.39, p = 0.01 for surgical resident and OR 6.46, p = 0.01) for advanced practice providers). CONCLUSION: There is wide variation in opioid prescription patterns by surgical providers. More studies are needed to clearly define the ideal number of tablets or MMEs to prescribe for common surgical procedures.
BACKGROUND: Surgeons play a pivotal role in the opioid epidemic but it is unknown how different members of a surgical team vary in the way they prescribe opioids after surgical episodes. STUDY DESIGN: We conducted a retrospective cohort study of all inpatient discharges for 5 common surgeries. Total number of tablets and total milligram equivalents (MME) prescribed were calculated and differences in prescription patterns were determined for attending surgeons, surgical residents and advanced practice providers. Using a generalized ordered logistic regression, we examined factors associated with ordering a higher number of tablets or MME. RESULTS: The median number of tablets (range) prescribed by rank were attending surgeon 30 (6-72), surgical resident 20 (6-189) and advanced care practitioner 40 (5-1000); p < 0.001.The median total MME prescribed by rank were attending surgeon 140 (30-600), surgical resident 200 (30-1600) and advanced practice provider 240 (25-1000); p < 0.001. There was no statistically significant difference by resident postgraduate year (PGY) for both total tablets and total MME prescribed. General surgery residents on average ordered a narrower range of total MME compared to surgical residents in other surgical specialties [20 (50-600) vs 20 (30-1600); p = 0.03]. On regression analysis, residents were less likely to order a higher number of tablets compared to attending surgeons (OR 0.29, p = 0.01). However, surgical residents and advanced care providers were more likely to prescribe a higher total MME compared to attending surgeons (OR 7.12, p < 0.001; OR 3.39, p = 0.01 for surgical resident and OR 6.46, p = 0.01) for advanced practice providers). CONCLUSION: There is wide variation in opioid prescription patterns by surgical providers. More studies are needed to clearly define the ideal number of tablets or MMEs to prescribe for common surgical procedures.
Authors: Roneet Lev; Oren Lee; Sean Petro; Jonathan Lucas; Edward M Castillo; Gary M Vilke; Christopher J Coyne Journal: Am J Emerg Med Date: 2015-09-08 Impact factor: 2.469
Authors: Katherine B Santosa; Christine S Wang; Hsou-Mei Hu; Chad M Brummett; Michael J Englesbe; Jennifer F Waljee Journal: Am J Surg Date: 2020-06-19 Impact factor: 2.565
Authors: Heidi N Overton; Marie N Hanna; William E Bruhn; Susan Hutfless; Mark C Bicket; Martin A Makary Journal: J Am Coll Surg Date: 2018-08-14 Impact factor: 6.113
Authors: Margaret E Smith; Jay S Lee; Aaron Bonham; Oliver A Varban; Jonathan F Finks; Arthur M Carlin; Amir A Ghaferi Journal: Surg Endosc Date: 2018-10-23 Impact factor: 4.584
Authors: Anish B Patel; Praveen N Satarasinghe; Victoria Valencia; Jessica L Wenzel; Jack C Webb; J Stuart Wolf; E Charles Osterberg Journal: J Clin Med Date: 2022-02-28 Impact factor: 4.241
Authors: Christian N Delgado; Imran S Yousaf; Anita Sadhu; Michael M Shipp; Kavya K Sanghavi; Aviram M Giladi Journal: J Hand Surg Glob Online Date: 2020-11-20
Authors: Joceline V Vu; David C Cron; Jay S Lee; Vidhya Gunaseelan; Pooja Lagisetty; Matthew Wixson; Michael J Englesbe; Chad M Brummett; Jennifer F Waljee Journal: Ann Surg Date: 2020-06 Impact factor: 13.787
Authors: David C Cron; Jay S Lee; James M Dupree; John D Syrjamaki; Hsou Mei Hu; William C Palazzolo; Michael J Englesbe; Chad M Brummett; Jennifer F Waljee Journal: Ann Surg Date: 2020-04 Impact factor: 13.787