Potential Opioid Overprescription May Be Common After Most Surgical Procedures

A nurse discussion prescriptions with patient post-surgery
A nurse discussion prescriptions with patient post-surgery
Opioids may be overprescribed frequently after surgery in most specialties.

Opioids may be overprescribed frequently after surgery in most specialties, including gynecology, obstetric, orthopedic, and plastic surgeries, according to a retrospective study published in JAMA Surgery.

For this cross-sectional study, investigators reviewed the medical records of 18,343 patients who underwent an inpatient surgical procedure with a postoperative length of hospital stay ≥24 hours. The researchers evaluated each patient’s opioid use at 24 hours after discharge and the total number of postdischarge prescriptions of opioid medications.

The investigators defined potential overprescription in this study as “the number of patients who used no opioids in the 24 hours prior to hospital discharge but were still prescribed opioids after hospital discharge.”

Among the patients who were not using opioid medications 24 hours before hospital discharge (n=6548), a total of 2988 (45.6%) patients received prescriptions for opioids at discharge, which may represent potential opioid overprescription. The service groups with the highest rates of opioid use at hospital discharge included obstetrics (adjusted odds ratio [AOR], 3.146; 95% CI, 2.094-4.765) and gynecology (AOR, 2.355; 95% CI, 1.663-3.390), orthopedics (AOR, 0.943; 95% CI, 0.719-1.242), and plastic surgery (AOR, 0.733; 95% CI, 0.334-1.682). Pediatric surgery was not associated with potential opioid overprescription (AOR, 2.09 × 10−7; 95% CI, 0.000-0.016).

As this study was focused on patients in Massachusetts, the findings may not be generalizable to other geographic areas. In addition, the investigators did not examine the opioid-sparing effects of nonopioid analgesics in this study, which could have limited the ability to fully evaluate each patient’s opioid use.

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These findings suggest that potential overprescription of opioids frequently occurs after surgery, and that “improved opioid prescribing practices are needed to administer opioids in a more patient-specific manner,” according to the investigators.

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Chen EY, Marcantonio A, Tornetta P. Correlation between 24-Hour predischarge opioid use and amount of opioids prescribed at hospital discharge [published online December 13, 2017]. JAMA Surg. doi: 10.1001/jamasurg.2017.4859