Postoperative opioid prescribing patterns and use after vascular surgery

Abstract

The aim of this study was to assess postoperative opioid prescribing patterns, usage, and pain control after common vascular surgery procedures in order to develop patient centered best-practice guidelines. We performed a prospective review of opioid prescribing after seven common vascular surgeries at a rural, academic medical center from December 2016 to July 2017. A standardized telephone questionnaire was prospectively administered to patients (n = 110) about opioid use and pain management perceptions. For comparison we retrospectively assessed opioid prescribing patterns (n = 939) from July 2014 to June 2016 normalized into morphine milligram equivalents (MME). Prescribers were surveyed regarding opioid prescription attitudes, perceptions, and practices. Opioids were prescribed for 78% of procedures, and 70% of patients reported using opioid analgesia. In the prospective group, the median MMEs prescribed were: VEIN (31, n = 16), CEA (40, n = 14), DIAL (60, n = 17), EVAR (108, n = 8), INFRA (160, n = 16), FEM TEA (200, n = 11), and OA (273, n = 4). The median proportion of opioids used by patients across all procedures was only 30% of the amount prescribed across all procedures (range 14-64%). Patients rated the opioid prescribed as appropriate (59%), insufficient (16%), and overprescribed (25%), and pain as very well controlled (47%), well controlled (47%), poorly controlled (4%), and very poorly controlled (2%). In conclusion, we observed significant variability in opioid prescribing after vascular procedures. The overall opioid use was substantially lower than the amount prescribed. These data enabled us to develop guidelines for opioid prescribing practice for our patients.

Prescribing Habits of Providers and Risk Factors for Nonadherence to Opioid Prescribing Guidelines

“…Support of standardized opioid prescribing stems from observed significant variations in inter-provider prescribing habits. [26][27][28][29] We found reduced variability in the opioid amount prescribed in the post-guidelines group, confirming this benefit of standardized opioid prescribing. Freedman-Weiss et al 30 found no difference between NPP and resident prescribing, whereas in our study, NPPs were more likely than residents to overprescribe opioids.…”

Postoperative Opioid Use in Rhinoplasty Procedures: A Standardized Regimen

“…They further noted that many pain pills went unused in the postoperative period. 11 Schwartz et al surveyed otolaryngologists and found that they prescribe an average of 19 AE 10 opioid tablets for septoplasty and 22 AE 10 for rhinoplasty. 12 Sethi et al found that average of 28 AE 11.4 narcotic tablets were prescribed to 173 rhinoplasty patients in their retrospective review.…”

Postoperative opioid prescription patterns and new opioid refills following cardiac implantable electronic device procedures

“…Our study showed that 20.2% of patients were prescribed opioids following CIED procedures. In comparison with other studies on postoperative opioid use, the opioid prescription rate was 59% after endovascular aneurysm repair 14 and 77% after hand surgery procedures. 15 In another study among general surgical procedures, ranging from partial mastectomy to open inguinal hernia repair, 90.5% of patients were prescribed an opioid.…”