The Association of Postoperative Opioid Prescriptions with Patient Outcomes

Abstract

To compare outcomes after surgery between patients who were not prescribed opioids and patients who were prescribed opioids. Summary of Background Data: Postoperative opioid prescriptions carry significant risks. Understanding outcomes among patients who receive no opioids after surgery may inform efforts to reduce these risks. Methods: We performed a retrospective study of adult patients who underwent surgery between January 1, 2019 and October 31, 2019. The primary outcome was the composite incidence of an emergency department visit, readmission, or reoperation within 30 days of surgery. Secondary outcomes were postoperative pain, satisfaction, quality of life, and regret collected via postoperative survey. A multilevel, mixed-effects logistic regression was performed to evaluate differences between groups. Results: In a cohort of 22,345 patients, mean age (standard deviation) was 52.1 (16.5) years and 13,269 (59.4%) patients were female. About 3175 (14.2%) patients were not prescribed opioids, of whom 422 (13.3%) met the composite adverse event endpoint compared to 2255 (11.8%) of patients not prescribed opioids (P = 0.015). Patients not prescribed opioids had a similar probability of adverse events {11.7% [95% confidence interval (CI) 10.2%−13.2%] vs 11.9% (95% CI 10.6%-13.3%]}. Among 12,872 survey respondents, patients who were not prescribed an opioid had a similar rate of high satisfaction [81.7% (95% CI 77.3%-86.1%) vs 81.7% (95% CI 77.7%-85.7%)] and no regret [(93.0% (95% CI 90.8%-95.2%) vs 92.6% (95% CI 90.4%-94.7%)].Conclusions: Patients who were not prescribed opioids after surgery had similar clinical and patient-reported outcomes as patients who were prescribed opioids. This suggests that minimizing opioids as part of routine postoperative care is unlikely to adversely affect patients.

Postoperative Opioid Prescribing and New Persistent Opioid Use

“…[30][31][32] These initiatives have achieved equal or superior levels of pain control and patient satisfaction compared to usual care. 27,33,34 Given the association between large prescriptions and persistent opioid use in the present study, these opioid-sparing efforts should continue to be adopted as the standard of care for postoperative recovery. Nevertheless, additional work is needed to understand the extent to which these practice changes will affect the incidence of persistent use after surgery.…”

“…This is distinct from prior claims-based studies that use immediate postoperative prescription fills as the main exposure because opioid prescriptions were identified from the MSQC clinical registry, which abstracts opioid prescriptions at the time of discharge from the medical record. 27 Among patients who received an opioid prescription, the secondary explanatory variable of interest was opioid prescription size, which was standardized to milligrams of oral morphine equivalents (OME) to adjust for the varying potencies of different types of opioids. For example, a 5 mg tablet of hydrocodone is equivalent to 5 mg OME, whereas a 5 mg tablet of oxycodone is equivalent to 7.5 mg OME.…”

Implementation and Assessment of No Opioid Prescription Strategy at Discharge After Major Urologic Cancer Surgery

“…In the NOPIOIDS group, which essentially received no opioid prescriptions, the satisfaction scores were high and pain scores remained low. Previous studies have noted the patient-reported outcomes survey response rates to be sometimes modest (<17%) or delayed (30-90 days after discharge), introducing significant selection or recall bias . In contrast, our patient-reported outcomes surveys in the group receiving no opioid prescriptions had a high response rate and were completed in real time.…”

A Neural Network Model Using Pain Score Patterns to Predict the Need for Outpatient Opioid Refills Following Ambulatory Surgery: Algorithm Development and Validation

“…Similarly, a 2017 systematic review reports that patients took only 29%-58% of the prescribed opioid pills [ 32 ]. Over the decades, we have learned that excess opioids do not necessarily reduce persistent postsurgical pain or any other pain-related outcomes [ 35 ]. As Porter and colleagues [ 36 ] demonstrated, sometimes less is more—patient-centered opioid discharge prescription guidelines satisfied 93% of the patients, with 99% in the 0 morphine milligram equivalents group [ 36 ].…”