Opioid analgesic use after ambulatory surgery: a descriptive prospective cohort study of factors associated with quantities prescribed and consumed (original) (raw)
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BMJ Open
IntroductionPostoperative pain is common and frequently addressed through opioid analgesia. This practice must balance the benefits of achieving adequate pain relief against the harms of adverse effects such as opioid-induced ventilatory impairment and opioid use disorder. This student and trainee-led collaborative study aims to investigate and compare the prescription versus consumption of opioids at 7 days postdischarge after common surgical procedures and their impact on patient-reported outcomes regarding postoperative pain.Methods and analysisThis is a prospective multicentre observational cohort study of surgical patients in Australia, Aotearoa New Zealand and select international sites, conducted by networks of students, trainees and consultants. Consecutive adult patients undergoing common elective and emergency general, orthopaedic, gynaecological and urological surgical procedures are eligible for inclusion, with follow-up 7 days after hospital discharge. The primary outco...
Canadian Pharmacists Journal / Revue des Pharmaciens du Canada
Background: In the midst of the North American opioid crisis, identifying and intervening on drivers of high-risk opioid prescriptions is an important step towards reducing iatrogenic harm. Objectives: We aimed to identify factors associated with variations in high-risk opioid discharge prescriptions, following select surgical procedures, to guide future quality improvement initiatives. Methods: This retrospective cohort study analyzed 1322 patients who underwent select open pelvic and open abdominal surgeries between January 1 and December 31, 2017, in a tertiary health care centre in Montreal. Results: Patients who underwent open abdominal surgeries were prescribed significantly higher daily doses of morphine milligram equivalents (MME) (45 mg; interquartile range, 30-60), than patients who underwent either a caesarean delivery (20 mg, 20-20) or a hysterectomy (30 mg, 22-30). After adjustment for multiple potential confounders, abdominal surgery was associated with 4 times the odd...
JAMA Surgery, 2018
Patterns of preoperative opioid use are not well characterized across different surgical services, and studies in this patient population have lacked important self-reported data of pain and affect. OBJECTIVES To assess the prevalence of preoperative opioid use and the characteristics of these patients in a broadly representative surgical cohort. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional, observational study of patients undergoing surgery at a tertiary care academic medical center. Data were collected as a part of large prospective institutional research registries from March 1, 2010, through April 30, 2016. EXPOSURES Preoperative patient and procedural characteristics, including prospectively assessed self-reported pain and functional measures. MAIN OUTCOMES AND MEASURES Patient-reported opioid use before surgery. RESULTS Of the total 34 186 patients recruited (54.2% women; mean [SD] age, 53.1 [16.1] years), preoperative opioid use was reported in 7894 (23.1%). The most common opioids used were hydrocodone bitartrate (4685 [59.4%]), tramadol hydrochloride (1677 [21.2%]), and oxycodone hydrochloride (1442 [18.3%]). Age of 31 to 40 years (adjusted odds ratio [
Journal of Pharmacy Practice and Research, 2019
There is sparse information on patterns of opioid use among opioid-na€ ıve surgical patients. This prospective observational study investigated patterns of opioid prescribing after hospital discharge, opioid use at 1 week and 1, 3 and 6 months after discharge, and associations between opioid use, pain control and opioid-related difficulties in opioid-na€ ıve surgical patients (age ≥18 years, not prescribed opioids in the previous 12 months, expected hospital length of stay >24 h after surgery). Of 128 participants recruited, 56.3% (n = 72) were male with a median (interquartile range) age of 66 (50.7-73.0) years; 38.3% (n = 49) were discharged with an opioid prescription postoperatively. After discharge, 37.3% (n = 25/67), 12.3% (n = 8/65), 12.5% (n = 6/48) and 2.4% (n = 1/42) of participants had used an opioid within 1 week and 1, 3 and 6 months, respectively. Low levels of pain were experienced overall postoperatively. There was considerable variation in opioid-related problems and concerns over time, with the most common being the desire to cease the opioid. Follow-up response rates were low, which limits the conclusions that can be drawn from the data. However, the findings indicate that opioids are commonly prescribed at discharge to opioid-na€ ıve surgical patients, with significant decline in use over time.
Post-Discharge Opioid Prescribing and Use after Common Surgical Procedure
Journal of the American College of Surgeons, 2018
The number of deaths from prescription opioids in the US continues to increase and remains a major public health concern. Opioid-related deaths parallel prescribing trends, and postoperative opioids are a significant source of opioids in the community. Our objective was to identify opioid prescribing and use patterns after surgery to inform evidence-based practices. Data from a 340-bed academic medical institution and its affiliated outpatient surgical facility included retrospective medical record data and prospective telephone questionnaire and medical record data. Retrospective data included patients discharged after 1 of 19 procedure types, from July 2015 to June 2016 (n = 10,112). Prospective data included a consecutive sample of general and orthopaedic surgery and urology patients undergoing 1 of 13 procedures, from July 2016 to February 2017 (n = 539). Primary outcomes were the quantity of opioid prescribed and used in morphine milligram equivalents (MME), and the proportion ...
Dose-response relationship between opioid use and adverse effects after ambulatory surgery
Journal of Pain and Symptom Management, 2004
This health outcomes analysis based on data from a randomized, double-blind, placebocontrolled trial determined dose-response relationship between opioid use and related symptoms. All patients received intravenous fentanyl on demand for pain predischarge, and oral acetaminophen 500 mg/hydrocodone 5 mg every 4-6 hours as needed postdischarge for up to 7 days postsurgery. Patients completed an opioid-related Symptom Distress Scale (SDS) questionnaire every 24 hours postdischarge for 7 days, which assessed 12 opioid-related symptoms by 3 ordinal measures: frequency, severity, and bothersomeness. Clinically meaningful events (CMEs) were defined based on the responses to this questionnaire. Opioid use was converted to morphine equivalent dose (MED). The doseresponse relationship between composite SDS scores and MED on Day 1, on Days 0 and 1, and on Days 1-4, was assessed. SDS scores for all 12 symptoms within the 3 dimensions were significantly associated with MED on Day 1 (F-value ϭ 1.56; P ϭ 0.04), as well as cumulative MED used on Days 0 and 1 (F-value ϭ 1.85; P Ͻ 0.01). Patients with a specific CME used a higher MED than those without a CME on Day 1 (P Ͻ 0.001). Between Days 1 and 4, patients with a higher number of patient-CME-days used a significantly higher MED. Regression analyses suggested that once the MED reached a threshold, approximately every 4 mg increase in MED was related to 1 additional patient-CME-day (P Ͻ 0.01). A dose-response relationship empirically exists between MED and directly assessed opioid-related CMEs after ambulatory laparoscopic cholecystectomy. Once daily MED reaches a threshold, every 3-4 mg increase will be associated with 1 additional clinically meaningful opioid-related symptom, or 1 additional patient-day with an opioidrelated CME.
Association between postoperative opioid use and outpatient surgical adverse events
The American Journal of Surgery, 2019
Background-Opioid-related adverse drug events are common following inpatient surgical procedures. Little is known about opioid prescribing after outpatient surgical procedures and if opioid use is associated with short term risks of outpatient surgical adverse events (AEs). Methods-VA Corporate Data Warehouse was used to identify opioid use within 48 hours for FY2012-14 chart-reviewed cases from a larger VA study of AEs in outpatient surgeries. We estimated a multilevel logistic regression model to determine the effect of opioid exposure on risk of AEs between 2-30 days postoperatively. Results-Of the 1,730 outpatient surgical cases, 628 (36%) had postoperative opioid use and 12% had an AE. Opioid use following outpatient surgery was not significantly associated with
Post-discharge opioid use and handling in surgical patients: A multicentre prospective cohort study
Anaesthesia and Intensive Care, 2020
Our aim was to determine the frequency and characteristics of post-surgery prescription of opioid medication and to describe patients’ handling of discharge opioid medications. We performed a multicentre prospective cohort study of adult patients undergoing elective or emergency surgery with a postoperative stay of one or more nights, with phone follow-up at two weeks after hospital discharge. The main outcome measures included the proportion of patients prescribed discharge opioid medications, post-discharge opioid use, opioid storage and disposal. Of the 1450 eligible surgical patients, opioids were dispensed on discharge to 858 (59%, 95% confidence interval (CI) (57%–62%)), with immediate-release oxycodone the most common medication. Of the 581 patients who were discharged with opioid medication and completed follow-up, 27% were still requiring opioids two weeks after discharge. Post-discharge opioid consumption was highly variable in the study cohort. The majority (70%) of patie...
Patient Factors Associated With Opioid Consumption in the Month Following Major Surgery
Annals of Surgery, 2019
Objective-Determine preoperative patient characteristics associated with postoperative outpatient opioid use and assess the frequency of postoperative opioid overprescribing. Summary Background Data-Although characteristics associated with inpatient opioid use have been described, the patient factors associated with opioid use after discharge are unknown but could inform the development of individualized approaches to postoperative prescribing. Methods-We included opioid-naïve patients undergoing hysterectomy, thoracic surgery, and total knee and hip arthroplasty in a single-center prospective observational cohort study. Preoperative phenotyping included self-report measures to assess pain severity, fibromyalgia survey criteria score, pain catastrophizing, depression, anxiety, functional status, fatigue, and sleep disturbance. Our primary outcome measure was self-reported total opioid use in oral morphine equivalents (OMEs). We constructed multivariable linear regression models predicting opioids consumed in the first postoperative month.