Opioid Prescriptions Following Common Surgeries: Optimal Durations

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Musculoskeletal procedures required the longest prescriptions and certain types of general and women's health procedures required the shortest prescriptions.
Musculoskeletal procedures required the longest prescriptions and certain types of general and women's health procedures required the shortest prescriptions.

According to recent research published in JAMA Surgery, the optimal duration of opioid prescriptions following surgical procedures was shown to vary from 4 to 15 days, depending on the type of surgical procedure, with musculoskeletal procedures requiring the longest prescriptions and certain types of general and women's health procedures requiring the shortest prescriptions.

In this cohort study, patterns of opioid prescribing after common surgeries were evaluated for adults (mean age, 40.1±12.8 years) who had undergone one of the following procedures: appendectomy (n=34,516), cholecystectomy (n=48,622), inguinal hernia repair (n=39,297), hysterectomy (n=39,474), mastectomy (n=5233), anterior cruciate ligament repair (n=16,511), rotator cuff repair (n=14,840), or discectomy (n=16,647). To determine the optimal length of initial opioid prescription, the researchers analyzed the risk for refilling an opioid prescription relative to the original prescription duration.

Of the more than 215,000 patients who underwent one of the common surgical procedures and filled their opioid prescription, 19.1% received 1 or more refill prescriptions.

The median opioid prescription length for the general surgery procedures appendectomy and cholecystectomy was 4 days. For inguinal hernia repair, the median was 5 days. Median prescription lengths were similar for women's health procedures, mastectomy and hysterectomy (5 and 4 days, respectively). For musculoskeletal procedures, prescriptions ranged from 5 days (anterior cruciate ligament and rotator cuff repairs) to 7 days (discectomy).

For general surgery procedures, the lowest probability of refill (10.7%) was noted in prescriptions for 9 days. For women's health procedures and musculoskeletal procedures, the lowest probability of refill was at 13 days (16.8%) and 15 days (32.5%), respectively.

According to the study authors, the optimal length of opioid prescription is between the observed median length and the earliest duration with the lowest risk for refill. Based on the results of the study, optimal opioid prescription lengths are 4 to 9 days for general surgery, 4 to 13 days for women's health procedures, and 6 to 15 days for musculoskeletal procedures.

The study authors concluded that “although 7-day limits on initial opioid pain medication prescriptions are likely adequate in many settings, and indeed also sufficient for many common general surgery and gynecologic procedures, in the postoperative setting, particularly after many orthopedic and neurosurgical procedures, a 7-day limit may be inappropriately restrictive.”

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Reference

Scully RE, Schoenfeld AJ, Jiang W, et al. Defining optimal length of opioid pain medication prescription after common surgical procedures [published online September 27, 2017]. JAMA Surg. doi: 10.1001/jamasurg.2017.3132

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