Opioid and non-opioid utilization at home following gastrointestinal procedures: a prospective cohort study

• Published in: Surgical endoscopy Vol. 34; no. 1; pp. 304 - 311
• Main Authors: Bartels, Karsten, Mahoney, Katharine, Raymond, Kristen M., McWilliams, Shannon K., Fernandez-Bustamante, Ana, Schulick, Richard, Hopfer, Christian J., Mikulich-Gilbertson, Susan K.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.01.2020; Springer Nature B.V
• Subjects: Abdominal Surgery; Adult; Analgesics; Analgesics, Non-Narcotic - therapeutic use; Analgesics, Opioid - therapeutic use; Cohort analysis; Digestive System Surgical Procedures - adverse effects; Digestive System Surgical Procedures - methods; Drug Utilization Review; Female; Gastroenterology; Gastrointestinal surgery; Gynecology; Hepatology; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Narcotics; Opioid-Related Disorders - etiology; Opioid-Related Disorders - prevention & control; Pain; Pain Management - methods; Pain, Postoperative - drug therapy; Patients; Practice Patterns, Physicians' - standards; Practice Patterns, Physicians' - statistics & numerical data; Proctology; Prospective Studies; Self report; Surgery; United States; United States; Analgesics, opioid; Patient discharge; Pain; Digestive system surgical procedures; Self-report
• ISSN: 0930-2794; 1432-2218; 1432-2218
• DOI: 10.1007/s00464-019-06767-1

Background Overprescribing of opioid medications for patients to be used at home after surgery is common. We sought to ascertain important patient and procedural characteristics that are associated with low versus high rates of self-reported utilization of opioids at home, 1–4 weeks after discharge following gastrointestinal surgery. Methods We developed a survey consisting of questions from NIH PROMIS tools for pain intensity/interference and queries on postoperative analgesic use. Adult patients completed the survey weekly during the first month after discharge. Using regression procedures we determined the patient and procedure characteristics that predicted high post-discharge opioid use operationalized as 75 mg oral morphine equivalents/50 mg oxycodone reported taken. Results The survey response rate was 86% (201/233). High opioid use was reported by 52.7% of patients (106/201). Median reported intake of opioid pain pills was 7 for week #1 and 0 for weeks #2–4. Combinations of acetaminophen and non-steroidal and anti-inflammatory drugs were used by 8.9%–12.5% of patients after discharge. Following adjustment for significant variables of the univariate analysis, last 24-h in-hospital opioid intake remained as a significant co-variate for post-discharge opioid intake. Conclusions After gastrointestinal surgery, the equivalent of each oxycodone 5 mg tablet taken in the last 24 h before discharge increases the likelihood of taking the equivalent of > 10 oxycodone 5 mg tablets by 5%. Non-opioid analgesia was utilized in less than half of the cases. Maximizing non-opioid analgesic therapy and basing opioid prescriptions on 24-h pre-discharge opioid intake may improve the quality of post-discharge pain management.