Assessing Opioids Prescribed After Low-Risk Surgical Procedures

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To understand patterns of postoperative opioid prescribing over time, researchers examined the trends of commonly-prescribed opioids after low-risk surgical procedures in the United States.
To understand patterns of postoperative opioid prescribing over time, researchers examined the trends of commonly-prescribed opioids after low-risk surgical procedures in the United States.

To understand patterns of postoperative opioid prescribing over time, researchers examined the trends of commonly-prescribed opioids after low-risk surgical procedures in the United States.

Hannah Wunsch, MD, MSc, of Sunnybrook Health Sciences Centre, Toronto, and colleagues examined trends in the amount of hydrocodone/acetaminophen and oxycodone/acetaminophen prescribed between 2004 and 2012.

Identifying patients from the Clinformatics Data Mart Database (OptumInsight), a repository that includes pharmacy and medical claims with data on services and procedures, the researchers collected data from approximately 14 million health care encounters of primarily commercially insured individuals. The sample size included opioid-naive adults (N = 155 297) who underwent 1 or more  low-risk surgical procedures in 2004, 2008, or 2012; carpal tunnel release, laparoscopic cholecystectomy (gallbladder removal), inguinal hernia repair, or knee arthroscopy. Specifically reviewing hydrocodone/acetaminophen or oxycodone/acetaminophen, the investigators analyzed patients who filled any opioid prescription in the 7 days after hospital discharge (inpatients) or on the procedure date (outpatients).

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Eighty percent filled a prescription for any opioid within 7 days (86% of these prescriptions were for either hydrocodone/acetaminophen or oxycodone/acetaminophen).   Taking into account all surgeries, the proportion of patients filling prescriptions for any opioid and for hydrocodone/acetaminophen and oxycodone/acetaminophen increased over time.

Additionally the researchers found that the average morphine equivalent dose increased over time for all procedures examined, with an increase of 18% in patients undergoing knee arthroscopy. The study's authors attribute this increase to the increase in the mean daily dose prescribed.

“Because the cohort was restricted to opioid-naive individuals, these changes are unlikely to represent an appropriate response by prescribing physicians to increasing rates of opioid tolerance over time within the population. Possible explanations include an increased focus on pain treatment or an increasing reliance on opioids for postoperative pain relief vs alternative therapies,” the authors wrote.

The investigators believe that further research needs to be conducted on how postoperative opioid prescribing practices have been contributing to the prescription opioid-related abuse epidemic.

Reference

Wunsch H, Wijeysundera DN, Passarella MA, Neuman MD. Opioids Prescribed After Low-Risk Surgical Procedures in the United States, 2004-2012. JAMA. 2016; doi:10.1001/jama.2016.0130.

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