Opioid prescribing practices and patient-requested refill patterns following laparoscopic inguinal hernia repair

• Published in: Hernia : the journal of hernias and abdominal wall surgery Vol. 27; no. 1; pp. 85 - 92
• Main Authors: Gentle, C. K., Thomas, J. D., Montelione, K. C., Tu, C., Prabhu, A. S., Krpata, D. M., Beffa, L. R., Rosenblatt, S., Rosen, M. J., Lo Menzo, E., Alaedeen, D., Szomstein, S., Massier, C. G., Petro, C. C.
• Format: Journal Article
• Language: English
• Published: Paris Springer Paris 01.02.2023; Springer Nature B.V
• Subjects: Abdominal Surgery; Analgesics, Opioid - therapeutic use; Hernia; Hernia, Inguinal - etiology; Hernia, Inguinal - surgery; Hernias; Herniorrhaphy - adverse effects; Humans; Laparoscopy; Male; Medicine; Medicine & Public Health; Narcotics; Opioids; Original; Original Article; Oxycodone; Pain; Pain, Postoperative - drug therapy; Pain, Postoperative - etiology; Patients; Practice Patterns, Physicians; Retrospective Studies; Surgery; Tablets; Post-operative pain; Patient-reported outcomes; Laparoscopic inguinal hernia repair; Opioid refills; Opioids
• ISSN: 1248-9204; 1265-4906; 1248-9204
• DOI: 10.1007/s10029-022-02708-5

Purpose Excessive post-operative opioid prescribing has led to efforts to match prescriptions with patient need after surgery. We investigated opioid prescribing practices, rate of patient-requested opioid refills, and associated factors after laparoscopic inguinal hernia repair (LIHR). Methods LIHRs at a single institution from 3/2019 to 3/2021 were queried from the Abdominal Core Health Quality Collaborative for demographics, perioperative details, and patient-reported opioid usage. Opioid prescriptions at discharge and opioid refills were extracted from the medical record. Univariate and multivariable regression were used to identify factors associated with opioid refills within 30-days of surgery. Results Four hundred and ninety LIHR patients were analyzed. The median number of opioid tablets prescribed was 12 [interquartile range (IQR) 10–15], and 4% requested a refill. On univariate analysis, patients who requested refills were younger [55 years (IQR 37–61) vs. 62 years (IQR 36.8–61), p  = 0.012], more likely to have undergone transabdominal preperitoneal repair (75% vs. 26.4%, p  < 0.001), have a scrotal component (30% vs. 11%, p  = 0.022), and have permanent tacks used (80% vs. 49.4%, p  = 0.014). There was a 12% increase in the odds of opioid refill for every 1 tablet of oxycodone prescribed at discharge (95% CI for OR 1.04–1.21, p  = 0.003) after controlling for age and surgery type. Patient-reported opioid use was available for 289 (59%) patients. Post-operatively, 67% of patients used ≤ 4 opioid tablets, and 87% used no more than 10 opioid tablets. Conclusion Most patients use fewer opioid tablets than prescribed. Requests for opioid refills are rare following LIHR (4%) and associated with higher opioid prescribing.