Clinician Characteristics Associated With Outpatient Postoperative Opioid Prescribing

Doctor and nurse tablet
Doctor and nurse tablet
Advanced practice providers were found to prescribe more opioids and in larger quantities compared with other physicians.

Advanced practice providers were found to prescribe more opioid medications and in larger quantities compared with other physicians, according to a study published in the Annals of Surgery.

Researchers retrospectively analyzed commercial insurance claims data from the Michigan Value Collaborative for 15,657 opioid-naive people who underwent surgery. The total amount of 30-day postoperative opioids filled per prescription (in oral morphine equivalents [OME]) was the study’s primary outcome. Associations between provider characteristics (eg, provider practice, advanced practice providers, and gender) and 30-day postoperative opioids filled per prescription was also examined.

At 30 days after surgery, the average amount of opioid prescription was 326±285 OME, corresponding to a total of 65 tablets of 5 mg hydrocodone. Advanced practice providers accounted for 19% of all opioid prescriptions, and the amount of opioid per prescription they filled was 18% larger compared with that of physicians (315 vs 268, respectively; P <.001).

 Primary care providers accounted for 13% of all opioid prescriptions (average, 279 OME/prescription). Male physicians were found to prescribe 10% more OME per prescription compared with female physicians (P <.001). Neurosurgeons represented the biggest prescribers among surgical specialties, with an average of 454 OME (95% CI, 420-492), with urologic surgeons found to prescribe the least amount of opioids (average, 178 OME; 95% CI, 161-196).

Considering this analysis included patients who were insured in Michigan, the findings from this study may not extrapolate to the broader patient population of the United States.

“All providers involved in the postoperative care of surgical patients can play an important role in developing best practices for responsible and safe postoperative opioid prescribing,” the investigators wrote. “Engaging each of these provider groups will be critical to understand existing prescribing practices and to tailor opioid prescribing policies and interventions accordingly.”

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Cron DC, Lee JS, Dupree JM, et al. Provider characteristics associated with outpatient opioid prescribing after surgery [published online September 20, 2018]. Ann Surg. doi: 10.1097/SLA.0000000000003013.