More Opioids Prescribed Later in Week and After Longer Inpatient Stay

More opioids were prescribed to postoperative patients later in the week and after prolonged hospitalizations, according to results of a study published in Surgery.

Though studies have shown a wide variation in postoperative opioid prescribing and that patients are at risk for chronic opioid abuse after surgery, the patterns of and factors contributing to differing prescribing behaviors have not yet been established.

To determine if the day of the week or the postoperative day at discharge affected prescribing patterns, data from 13,545 outpatient and 10,838 inpatient surgeries were analyzed. Patients who underwent commonly performed procedures at The Mount Sinai Hospital in New York, NY from January 2014 through April 2019 and received a postoperative opioid prescription were included.

In ambulatory operations, each successive day of the week after Monday that a patient was discharged was associated with an increase of 1.4 oral morphine milligram equivalents (MME) prescribed (P =.0080).

Patients who were men or who underwent operations of longer duration were prescribed significantly higher doses than their counterparts (P <.0001). Individuals who were smokers were prescribed significantly higher MME (P =.0085). Hispanic individuals had significantly fewer MME prescribed (P <.0001).

For inpatient operations, surgeons prescribed more MME at discharge in the latter half of the week and the weekend than the first half (P =.0372). Each additional postoperative day before discharge was associated with 18.99 additional MME prescribed (P <.0001).

Patients who were women, were smokers, or underwent operations of longer duration were prescribed significantly higher doses than their counterparts (P <.0001). Patients with Medicare health insurance received opioid prescriptions 52.71 MME higher than those with private insurance (P =.0008) and patients with Medicaid received prescriptions 114.35 MME higher than those with private insurance (P =.0001).

The results of this study indicated that the latter days of the week on which a postoperative patient was discharged, whether it be ambulatory or inpatient surgery, are associated with significantly higher opioid prescriptions.

The authors suggest that surgeons likely “prescribe greater numbers of MME later in the week to avoid pain-related phone calls and complications during the weekend that are more readily handled during the week with normally operating clinics during business hours.” The increase in MME prescribed for each additional postoperative day before discharge may be due to the greater severity of operation or presence of postoperative complications, which would result in both a longer inpatient stay and a need for greater MME prescriptions.

A limitation to this study is its retrospective and cross-sectional design, which limits the amount of data that can be acquired, such as whether a patient had a history of chronic pain or if refills were ordered. Further investigation into the significant differences in MME prescribed to men and Hispanic individuals is warranted.

Reference

Lazar DJ, Zaveri S, Khetan P, Nobel TB, Divino CM. Variations in postoperative opioid prescribing by day of week and duration of hospital stay. Published online July 16, 2020. Surgery. doi:10.1016/j.surg,2020.05.047