Opioid prescribing in orthopaedic and neurosurgical specialties in a tertiary hospital: a retrospective audit of hospital discharge data

Abstract

Background: To understand patterns of opioid prescribing on discharge in the orthopaedic and neurosurgical wards of a tertiary metropolitan hospital. Methods: A retrospective audit of medical records and discharge summaries for all orthopaedic and neurosurgical patients admitted for at least 2 days on two surgical wards over a 6-month period between 1 January and 30 June 2017. Results: A combined total of 355 patients (281 orthopaedic and 74 neurosurgical patients) were included in the audit. Approximately 82% were discharged on opioids. Of patients discharged on opioids, 71.4% of the orthopaedic group and 73.8% of the neurosurgical group were discharged on combinations of two or more opioids (immediate release together with slow release). Around 65% of the sample discharged on opioids was opioid naïve on admission. About 32.5% of the orthopaedic patients and 68.9% of the neurosurgical patients were discharged on a combination of opioid and other pharmacotherapy that could potentiate the central nervous system depressant effect of the opioids. Only 6.9% of orthopaedic patients and 11.5% of the neurosurgical patients had discharge summaries that included any reference to opioid management after discharge. Conclusion: Orthopaedic and neurosurgical units had high opioid prescribing rates on discharge from hospital. This highlights the need for clear communication of the intended medication management plan post-discharge in order to minimize inappropriate and ongoing use of opioids post-surgery.

Chronic opioid use following anterior cervical discectomy and fusion surgery for degenerative cervical pathology

“…Although the majority of opioid-related deaths can be attributed to illicit opioids, prescription opioids still contribute to almost 40% of overdose deaths [4]. Orthopedic and neurosurgeons are among the specialties that prescribe the highest amount of opioids [5,6], and anterior cervical discectomy and fusion (ACDF) is among the most commonly performed spinal surgeries with more than 30,000 surgeries performed every year [7−9]. Given that opioid medications are standard of care for postoperative pain control following spine surgery, it is important to understand current trends in opioid prescribing following ACDF and risk factors for prolonged postoperative opioid use.…”

Opioid prescribing improvement in orthopaedic specialty unit in a tertiary hospital: a retrospective audit of hospital discharge data pre‐ and post‐intervention for better opioid prescribing practice

“…For example, IR formulations only on discharge more than doubled post‐intervention, aligning with the latest best practice guidelines (e.g. IR opioid only, lowest effective dose and no more than 3 days supply) …”

“…Potential drug interactions with opioids on discharge were detected in almost one‐third of patients (32.5%, n = 75). Details of these interactions are reported elsewhere …”

“…Where there were missing data from the current admission record, previous admission Medical Records Online were interrogated for data. Further details of data collection are reported in the original audit …”

“…A retrospective audit of our tertiary metropolitan hospital discharge data in 2017 showed high rates of opioid prescription in both orthopaedic and neurosurgical wards for patients upon discharge . These high levels of prescription and their potential for increased risk of adverse consequences were identified as the baseline from which to improve practice.…”