Opioid utilization in minimally invasive versus open inguinal hernia repair

Knight, Ariel W.; Habermann, Elizabeth B.; Ubl, Daniel S.; Zielinski, Martin D.; Thiels, Cornelius A.

doi:10.1016/j.surg.2019.05.012

Cited by 25 publications

(19 citation statements)

References 15 publications

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“…As such, opioids should only be prescribed when necessary and at the lowest possible effective dose [18]. Substantial progress has been made over the past 5 years regarding opioid-sparing postoperative protocols and decreased discharge [2,6,[18][19][20], with growing evidence that many patients may require at most only three pills [2,6,14,21,22]. In addition, limits on duration and/or doses of opioids have been enacted by state programs, large payers, and pharmacy chains and benefit managers [23].…”

Section: Discussionmentioning

confidence: 99%

“…Substantial progress has been made over the past 5 years regarding opioid-sparing postoperative protocols and decreased discharge prescription opioid quantities. Current literature recommends a discharge prescription range of 0 to 15 oxycodone (5 mg) pills for inguinal herniorrhaphy [ 2 , 6 , 18 – 20 ], with growing evidence that many patients may require at most only three pills [ 2 , 6 , 14 , 21 , 22 ]. In addition, limits on duration and/or doses of opioids have been enacted by state programs, large payers, and pharmacy chains and benefit managers [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

“…The use of scheduled non-opioid MMA alone for inguinal hernia repair (open and laparoscopic), based on current literature, results in approximately 15–64% of patients recovering opioid-free [ 2 , 3 , 6 , 12 , 14 , 22 ]. Though the primary objective of the current study was not to assess the impact of HTX-011 on the rate of opioid-free patients, the use of HTX-011 in combination with scheduled non-opioid MMA resulted in 95% of patients overall with an opioid-free recovery through the 15-day follow-up period.…”

Section: Discussionmentioning

confidence: 99%

“…Worldwide, herniorrhaphy is a common surgery, with more than 20 million procedures performed each year [1]; 800,000 inguinal hernias are repaired annually in the United States [2,3]. Despite the increased use of non-opioid multimodal analgesia (MMA) and successful efforts to decrease opioid prescribing, current evidence indicates that opioid medications are still overprescribed after common general surgical procedures, including herniorrhaphy, with approximately 70% of tablets going unused by patients [2][3][4][5][6]. Opioids and their overprescribing in the postoperative setting are associated with adverse events (AEs) and the potential for long-term dependence and diversion [7].…”

Section: Introductionmentioning

confidence: 99%

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Opioid-Free Recovery After Hernia Repair with HTX-011 as the Foundation of a Non-Opioid, Multimodal Analgesia Regimen in a Real-World Setting: A Randomized, Open-Label Study

Minkowitz¹,

Soto

Fanikos

et al. 2021

Pain Ther

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both regimens, and 95% of patients had an opioid-free recovery. No patient discharged without a prescription called back to request one. Treatment was well tolerated, without evidence of nonsteroidal anti-inflammatory drug-related toxicity. Conclusions: HTX-011, used with over-thecounter products ibuprofen/acetaminophen and personalized opioid prescription algorithm in a real-world environment, has the potential to reduce opioid use and opioid prescriptions after herniorrhaphy without compromising patient satisfaction. Trial Registration: ClinicalTrials.gov, NCT032 37481.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Opioid-Free Recovery After Hernia Repair with HTX-011 as the Foundation of a Non-Opioid, Multimodal Analgesia Regimen in a Real-World Setting: A Randomized, Open-Label Study

Minkowitz¹,

Soto

Fanikos

et al. 2021

Pain Ther

View full text Add to dashboard Cite

show abstract

“…6,7 Several studies have attempted to characterize the amounts of opioids required after certain general surgery, gynecologic, and orthopedic procedures. 4,[8][9][10][11][12] However, few prospective studies exist and many of these reports have been based on retrospective review and expert consensus. Despite these attempts to create uniformity, there is still a wide range of acceptable prescription amounts.…”

Section: Introductionmentioning

confidence: 99%

Postoperative Opioid Utilization and Patient Satisfaction in General Surgery Procedures: A Prospective Observational Study

Linnaus

Neville

Habermann

et al. 2021

The American Surgeon™

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Background Wide variation of opioid prescribing persists despite attempts to quantify number of opioids utilized postoperatively. We aim to prospectively determine number of opioids used after common surgery procedures to guide future prescribing. Methods A prospective observational trial was performed of opioids prescribed and used postoperatively. Patients filled out pre- and postoperative surveys, and number of opioids utilized was captured at postoperative visit. Results One-hundred-and-thirteen patients met inclusion. Median opioids prescribed exceeded number of opioids taken for all procedures. Median number of opioids taken postoperatively was fewer than 10 for all categories of procedures: simple skin/soft tissue 2 (IQR 1-4), complex skin/soft tissue 1.5 (IQR 0-14), simple laparoscopy 1 (IQR 0-20) and complex laparoscopy 4 (IQR 0-20), laparotomy 0 (IQR 0-26), and open inguinal hernia 2 (IQR 0-2). Nearly 80% of patients had leftover opioids, and 31% planned to keep them. There was little difference between preoperative and postoperative level of satisfaction with a pain control regimen. Discussion Postoperatively, patients utilize opioids less frequently than prescribed and often keep leftover pills. Patient pain control satisfaction is unrelated to number of opioids prescribed and taken postoperatively.

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What defines the “value” of robotic surgery for patients with gastrointestinal cancers? Perspectives from a U.S. Cancer Center

Ikoma

2024

Annals of Gastroent Surgery

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The use of robotic surgery has experienced rapid growth across diverse medical conditions, with a notable emphasis on gastrointestinal cancers. The advanced technologies incorporated into robotic surgery platforms have played a pivotal role in enabling the safe performance of complex procedures, including gastrectomy and pancreatectomy, through a minimally invasive approach. However, there exists a noteworthy gap in high‐level evidence demonstrating that robotic surgery for gastric and pancreatic cancers has substantial benefits compared to traditional open or laparoscopic methods. The primary impediment hindering the broader implementation of robotic surgery is its cost. The escalating healthcare expenses in the United States have prompted healthcare providers and payors to explore patient‐centered, value‐based healthcare models and reimbursement systems that embrace cost‐effectiveness. Thus, it is important to determine what defines the value of robotic surgery. It must either maintain or enhance oncological quality and improve complication rates compared to open procedures. Moreover, its true value should be apparent in patients' expedited recovery and improved quality of life. Another essential aspect of robotic surgery's value lies in minimizing or even eliminating opioid use, even after major operations, offering considerable benefits to the broader public health landscape. A quicker return to oncological therapy has the potential to improve overall oncological outcomes, while a speedier return to work not only alleviates individual financial distress but also positively impacts societal productivity. In this article, we comprehensively review and summarize the current landscape of health economics and value‐based care, with a focus on robotic surgery for gastrointestinal cancers.

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Opioid utilization in minimally invasive versus open inguinal hernia repair

Cited by 25 publications

References 15 publications

Opioid-Free Recovery After Hernia Repair with HTX-011 as the Foundation of a Non-Opioid, Multimodal Analgesia Regimen in a Real-World Setting: A Randomized, Open-Label Study

Opioid-Free Recovery After Hernia Repair with HTX-011 as the Foundation of a Non-Opioid, Multimodal Analgesia Regimen in a Real-World Setting: A Randomized, Open-Label Study

Postoperative Opioid Utilization and Patient Satisfaction in General Surgery Procedures: A Prospective Observational Study

What defines the “value” of robotic surgery for patients with gastrointestinal cancers? Perspectives from a U.S. Cancer Center

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