Josh Bleicher1, Zachary Fender2, Jordan E Johnson2, Brian T Cain2, Kathy Phan3, Damien Powers3, Guo Wei4, Angela P Presson4, Alvin Kwok2, T Bartley Pickron5, Courtney L Scaife5, Lyen C Huang5. 1. Department of Surgery, University of Utah, Salt Lake City, UT, USA. Electronic address: Josh.bleicher@hsc.utah.edu. 2. Department of Surgery, University of Utah, Salt Lake City, UT, USA. 3. Division of Pharmacy, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, USA. 4. Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, USA. 5. Department of Surgery, University of Utah, Salt Lake City, UT, USA; Department of Surgery, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.
Abstract
BACKGROUND: Leftover pills from postoperative opioid prescriptions place patients and members of their communities at risk for opioid misuse. We aimed to better understand patients' post-discharge opioid consumption patterns to inform new methods of postoperative opioid prescribing. METHODS: We assessed post-discharge opioid consumption of general surgery patients and assessed the adequacy of discharge opioid prescriptions. We then compared patient opioid consumption to a number of theoretical discharge prescriptions based on different opioid prescribing guidelines and a proposed discharge prescription based on the metric 24-h pre-discharge opioid consumption (PDOC). RESULTS: 62/99 patients (62.6%) returned an opioid log book. Median 24-h PDOC was 22.5 MME (IQR 5.0-45.0) and median discharge prescription size was 15 pills (IQR:10-20). Prescriptions were adequate for 83.7% of patients. The median number of pills used was 3 (IQR:0-11) and median time to opioid cessation was 3 days (IQR:0-5). Actual prescriptions were consistent with national opioid prescribing guidelines. Prescriptions based on the formula 2 × 24-h PDOC would have decreased the number of leftover pills by 7.5 per patient. CONCLUSIONS: Despite prescribing opioids consistent with national opioid prescribing guidelines, patients still receive too many pills. Improved opioid prescribing could be accomplished by use of the formula 2 × 24-h PDOC.
BACKGROUND: Leftover pills from postoperative opioid prescriptions place patients and members of their communities at risk for opioid misuse. We aimed to better understand patients' post-discharge opioid consumption patterns to inform new methods of postoperative opioid prescribing. METHODS: We assessed post-discharge opioid consumption of general surgery patients and assessed the adequacy of discharge opioid prescriptions. We then compared patient opioid consumption to a number of theoretical discharge prescriptions based on different opioid prescribing guidelines and a proposed discharge prescription based on the metric 24-h pre-discharge opioid consumption (PDOC). RESULTS: 62/99 patients (62.6%) returned an opioid log book. Median 24-h PDOC was 22.5 MME (IQR 5.0-45.0) and median discharge prescription size was 15 pills (IQR:10-20). Prescriptions were adequate for 83.7% of patients. The median number of pills used was 3 (IQR:0-11) and median time to opioid cessation was 3 days (IQR:0-5). Actual prescriptions were consistent with national opioid prescribing guidelines. Prescriptions based on the formula 2 × 24-h PDOC would have decreased the number of leftover pills by 7.5 per patient. CONCLUSIONS: Despite prescribing opioids consistent with national opioid prescribing guidelines, patients still receive too many pills. Improved opioid prescribing could be accomplished by use of the formula 2 × 24-h PDOC.
Authors: Chad M Brummett; Jennifer F Waljee; Jenna Goesling; Stephanie Moser; Paul Lin; Michael J Englesbe; Amy S B Bohnert; Sachin Kheterpal; Brahmajee K Nallamothu Journal: JAMA Surg Date: 2017-06-21 Impact factor: 14.766
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: Kristin E Rojas; Donna-Marie Manasseh; Peter L Flom; Solomon Agbroko; Nicole Bilbro; Charusheela Andaz; Patrick I Borgen Journal: Breast Cancer Res Treat Date: 2018-06-18 Impact factor: 4.872
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: Katie G Egan; Michelle De Souza; Elizabeth Muenks; Niaman Nazir; Richard Korentager Journal: Ann Surg Oncol Date: 2020-04-13 Impact factor: 5.344
Authors: Liese C C Pruitt; Douglas S Swords; Sathya Vijayakumar; Barbara Ostlund; Jeannette Prochazka; Nathan G Richards; Brian T Bucher; David E Skarda Journal: J Surg Res Date: 2019-10-24 Impact factor: 2.192