Haytham M A Kaafarani1, Kelsey Han1, Mohamad El Moheb1, Napaporn Kongkaewpaisan1,2, Zhenyi Jia1,3, Majed W El Hechi1, Suzanne van Wijck1,4, Kerry Breen1, Ahmed Eid1, Gabriel Rodriguez1, Manasnun Kongwibulwut1,5, Ask T Nordestgaard1, Joseph V Sakran6, Hiba Ezzeddine6, Bellal Joseph7, Mohammad Hamidi7, Camilo Ortega8, Sonia Lopez Flores9, Bernardo J Gutierrez-Sougarret9, Huanlong Qin10, Jun Yang3, Renyuan Gao10, Zhiguo Wang11, Zhiguang Gao12, Supparerk Prichayudh13, Said Durmaz4, Gwendolyn van der Wilden4, Stephanie Santin14, Marcelo A F Ribeiro15, Napakadol Noppakunsomboom2, Ramzi Alami16, Lara El-Jamal16, Dana Naamani16, George Velmahos1, Keith D Lillemoe1. 1. Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts. 2. Division of Acute Care and Ambulatory Surgery, Siriraj Hospital, Mahidol University, Bangkok, Thailand. 3. Department of General Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China. 4. Department of Trauma Surgery, Leiden University Medical Center, Leiden, The Netherlands. 5. Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. 6. Division of Acute Care Surgery, Emergency General Surgery, The Johns Hopkins University, Baltimore, Maryland. 7. Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona. 8. Hospital Departamental Villavicencio, Villavicencio, Colombia. 9. Department of Anesthesia, Hospital Angeles Pedregal, Mexico City, Mexico. 10. Department of General Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China. 11. Department of Colorectal Surgery, Changzheng Hospital, Navy Medical University, Shanghai, People's Republic of China. 12. Department of Emergency Surgery, Shanghai East Hospital of Tongji University, Shanghai, People's Republic of China. 13. Department of Surgery, King Chulalongkorn Memorial Hospital, Bangkok, Thailand. 14. Department of Surgery, Hospital Brasil Rede D'Or, São Paulo, SP, Brazil. 15. Post Graduation Program, Hospital Servidor Publico Estadual IAMSPE, Hospital Moriah, São Paulo, SP, Brazil. 16. Department of Surgery, American University of Beirut, Beirut, Lebanon.
Abstract
OBJECTIVE: The International Patterns of Opioid Prescribing study compares postoperative opioid prescribing patterns in the United States (US) versus the rest of the world. SUMMARY OF BACKGROUND DATA: The US is in the middle of an unprecedented opioid epidemic. Diversion of unused opioids contributes to the opioid epidemic. METHODS: Patients ≥16 years old undergoing appendectomy, cholecystectomy, or inguinal hernia repair in 14 hospitals from 8 countries during a 6-month period were included. Medical records were systematically reviewed to identify: (1) preoperative, intraoperative, and postoperative characteristics, (2) opioid intake within 3 months preoperatively, (3) opioid prescription upon discharge, and (4) opioid refills within 3 months postoperatively. The median/range and mean/standard deviation of number of pills and OME were compared between the US and non-US patients. RESULTS: A total of 4690 patients were included. The mean age was 49 years, 47% were female, and 4% had opioid use history. Ninety-one percent of US patients were prescribed opioids, compared to 5% of non-US patients (P < 0.001). The median number of opioid pills and OME prescribed were 20 (0-135) and 150 (0-1680) mg for US versus 0 (0-50) and 0 (0-600) mg for non-US patients, respectively (both P < 0.001). The mean number of opioid pills and OME prescribed were 23.1 ± 13.9 in US and 183.5 ± 133.7 mg versus 0.8 ± 3.9 and 4.6 ± 27.7 mg in non-US patients, respectively (both P < 0.001). Opioid refill rates were 4.7% for US and 1.0% non-US patients (P < 0.001). CONCLUSIONS: US physicians prescribe alarmingly high amounts of opioid medications postoperatively. Further efforts should focus on limiting opioid prescribing and emphasize non-opioid alternatives in the US.
OBJECTIVE: The International Patterns of Opioid Prescribing study compares postoperative opioid prescribing patterns in the United States (US) versus the rest of the world. SUMMARY OF BACKGROUND DATA: The US is in the middle of an unprecedented opioid epidemic. Diversion of unused opioids contributes to the opioid epidemic. METHODS: Patients ≥16 years old undergoing appendectomy, cholecystectomy, or inguinal hernia repair in 14 hospitals from 8 countries during a 6-month period were included. Medical records were systematically reviewed to identify: (1) preoperative, intraoperative, and postoperative characteristics, (2) opioid intake within 3 months preoperatively, (3) opioid prescription upon discharge, and (4) opioid refills within 3 months postoperatively. The median/range and mean/standard deviation of number of pills and OME were compared between the US and non-US patients. RESULTS: A total of 4690 patients were included. The mean age was 49 years, 47% were female, and 4% had opioid use history. Ninety-one percent of US patients were prescribed opioids, compared to 5% of non-US patients (P < 0.001). The median number of opioid pills and OME prescribed were 20 (0-135) and 150 (0-1680) mg for US versus 0 (0-50) and 0 (0-600) mg for non-US patients, respectively (both P < 0.001). The mean number of opioid pills and OME prescribed were 23.1 ± 13.9 in US and 183.5 ± 133.7 mg versus 0.8 ± 3.9 and 4.6 ± 27.7 mg in non-US patients, respectively (both P < 0.001). Opioid refill rates were 4.7% for US and 1.0% non-US patients (P < 0.001). CONCLUSIONS: US physicians prescribe alarmingly high amounts of opioid medications postoperatively. Further efforts should focus on limiting opioid prescribing and emphasize non-opioid alternatives in the US.
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