Heidi N Overton1, Marie N Hanna2, William E Bruhn1, Susan Hutfless3, Mark C Bicket4, Martin A Makary5. 1. Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD. 2. Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD. 3. Department of Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD. 4. Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. 5. Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Electronic address: mmakary1@jhmi.edu.
Abstract
BACKGROUND: One in 16 surgical patients prescribed opioids becomes a long-term user. Overprescribing opioids after surgery is common, and the lack of multidisciplinary procedure-specific guidelines contributes to the wide variation in opioid prescribing practices. We hypothesized that a single-institution, multidisciplinary expert panel can establish consensus on ideal opioid prescribing for select common surgical procedures. STUDY DESIGN: We used a 3-step modified Delphi method involving a multidisciplinary expert panel of 6 relevant stakeholder groups (surgeons, pain specialists, outpatient surgical nurse practitioners, surgical residents, patients, and pharmacists) to develop consensus ranges for outpatient opioid prescribing at the time of discharge after 20 common procedures in 8 surgical specialties. Prescribing guidelines were developed for opioid-naïve adult patients without chronic pain undergoing uncomplicated procedures. The number of opioid tablets was defined using oxycodone 5 mg oral equivalents. RESULTS: For all 20 surgical procedures reviewed, the minimum number of opioid tablets recommended by the panel was 0. Ibuprofen was recommended for all patients unless medically contraindicated. The maximum number of opioid tablets varied by procedure (median 12.5 tablets), with panel recommendations of 0 opioid tablets for 3 of 20 (15%) procedures, 1 to 15 opioid tablets for 11 of 20 (55%) procedures, and 16 to 20 tablets for 6 of 20 (30%) procedures. Overall, patients who had the procedures voted for lower opioid amounts than surgeons who performed them. CONCLUSIONS: Procedure-specific prescribing recommendations may help provide guidance to clinicians who are currently overprescribing opioids after surgery. Multidisciplinary, patient-centered consensus guidelines for more procedures are feasible and may serve as a tool in combating the opioid crisis.
BACKGROUND: One in 16 surgical patients prescribed opioids becomes a long-term user. Overprescribing opioids after surgery is common, and the lack of multidisciplinary procedure-specific guidelines contributes to the wide variation in opioid prescribing practices. We hypothesized that a single-institution, multidisciplinary expert panel can establish consensus on ideal opioid prescribing for select common surgical procedures. STUDY DESIGN: We used a 3-step modified Delphi method involving a multidisciplinary expert panel of 6 relevant stakeholder groups (surgeons, pain specialists, outpatient surgical nurse practitioners, surgical residents, patients, and pharmacists) to develop consensus ranges for outpatient opioid prescribing at the time of discharge after 20 common procedures in 8 surgical specialties. Prescribing guidelines were developed for opioid-naïve adult patients without chronic pain undergoing uncomplicated procedures. The number of opioid tablets was defined using oxycodone 5 mg oral equivalents. RESULTS: For all 20 surgical procedures reviewed, the minimum number of opioid tablets recommended by the panel was 0. Ibuprofen was recommended for all patients unless medically contraindicated. The maximum number of opioid tablets varied by procedure (median 12.5 tablets), with panel recommendations of 0 opioid tablets for 3 of 20 (15%) procedures, 1 to 15 opioid tablets for 11 of 20 (55%) procedures, and 16 to 20 tablets for 6 of 20 (30%) procedures. Overall, patients who had the procedures voted for lower opioid amounts than surgeons who performed them. CONCLUSIONS: Procedure-specific prescribing recommendations may help provide guidance to clinicians who are currently overprescribing opioids after surgery. Multidisciplinary, patient-centered consensus guidelines for more procedures are feasible and may serve as a tool in combating the opioid crisis.
Authors: Eddie Blay; Michael J Nooromid; Karl Y Bilimoria; Jane L Holl; Bruce Lambert; Julie K Johnson; Jonah J Stulberg Journal: Am J Surg Date: 2017-11-01 Impact factor: 2.565
Authors: Brian T Bateman; Naida M Cole; Ayumi Maeda; Sara M Burns; Timothy T Houle; Krista F Huybrechts; Caitlin R Clancy; Stephanie B Hopp; Jeffrey L Ecker; Holly Ende; Kasey Grewe; Beatriz Raposo Corradini; Robert E Schoenfeld; Keerthana Sankar; Lori J Day; Lynnette Harris; Jessica L Booth; Pamela Flood; Melissa E Bauer; Lawrence C Tsen; Ruth Landau; Lisa R Leffert Journal: Obstet Gynecol Date: 2017-07 Impact factor: 7.661
Authors: Nayoung Kim; Jonas L Matzon; Jack Abboudi; Christopher Jones; William Kirkpatrick; Charles F Leinberry; Frederic E Liss; Kevin F Lutsky; Mark L Wang; Mitchell Maltenfort; Asif M Ilyas Journal: J Bone Joint Surg Am Date: 2016-10-19 Impact factor: 5.284
Authors: Gabriel A Brat; Denis Agniel; Andrew Beam; Brian Yorkgitis; Mark Bicket; Mark Homer; Kathe P Fox; Daniel B Knecht; Cheryl N McMahill-Walraven; Nathan Palmer; Isaac Kohane Journal: BMJ Date: 2018-01-17
Authors: Heather A Lillemoe; Timothy E Newhook; Timothy J Vreeland; Elsa M Arvide; Whitney L Dewhurst; Elizabeth G Grubbs; Thomas A Aloia; Jean-Nicolas Vauthey; Jeffrey E Lee; Ching-Wei D Tzeng Journal: Ann Surg Oncol Date: 2019-04-01 Impact factor: 5.344
Authors: Catherine L Chen; Molly Moore Jeffery; Erin E Krebs; Cornelius A Thiels; Mark A Schumacher; Adam J Schwartz; Robert Thombley; Emily Finlayson; Rosa Rodriguez-Monguio; Derek Ward; R Adams Dudley Journal: J Am Acad Orthop Surg Glob Res Rev Date: 2020-01-07
Authors: Katherine B Santosa; Hsou-Mei Hu; Chad M Brummett; Margaret A Olsen; Michael J Englesbe; Eva A Williams; Jennifer F Waljee Journal: Surgery Date: 2019-07-23 Impact factor: 3.982
Authors: Tracy-Ann Moo; Kate R Pawloski; Varadan Sevilimedu; Jillian Charyn; Brett A Simon; Lisa M Sclafani; George Plitas; Andrea V Barrio; Laurie J Kirstein; Kimberly J Van Zee; Monica Morrow Journal: Ann Surg Oncol Date: 2020-07-30 Impact factor: 5.344
Authors: Sara J Hyland; Kara K Brockhaus; William R Vincent; Nicole Z Spence; Michelle M Lucki; Michael J Howkins; Robert K Cleary Journal: Healthcare (Basel) Date: 2021-03-16
Authors: Jacqueline A Carrico; Katharine Mahoney; Kristen M Raymond; Shannon K McWilliams; Lena M Mayes; Susan K Mikulich-Gilbertson; Karsten Bartels Journal: Ann Fam Med Date: 2020-03 Impact factor: 5.166