Prevalence and Predictors of Opioid Prescription at Discharge after Emergency General Surgery

Abstract

The prevalence of moderate-to-severe pain after hospital discharge in patients after general surgery procedures is high, and opioids are a predominant analgesic agent used to treat pain in this population. Post-discharge pain and prescribing patterns are unknown in the emergency general surgery (EGS) population. Our aim was to study the proportion and predictors of opioid prescription in EGS patients at discharge. The 2007 to 2013 TRICARE insurance database was queried for opioid-naive patients 18-64 years, who underwent an EGS procedure. The outcome was prescription of opioid analgesics at discharge. Data collection included patient demographics and clinical characteristics. Logistic regression models were used to determine the predictors of opioid prescription. A total of 26,647 patients met our inclusion criteria where 3,476 (13%) received an opioid prescription at discharge. In multivariate analysis, male sex (odds ratio [OR]: 2.12, 95% CI: 1.78–2.51) and rank (enlisted-seniors vs officers, OR: 1.23, 95% CI: 1.04–1.45) were associated with higher likelihood of opioid prescription. Depression diagnosis (OR: 0.38, CI: 0.26–0.54), anxiety diagnosis (OR: 0.26, CI: 0.17–0.38) and pre-existing comorbidities (Charlson Comorbidity Index ≥ 1, OR: 0.61, CI: 0.47–0.79) were associated with decreased likelihood of opioid prescription. Age and race were not significant predictors of opioid prescription. The rate of opioid prescription in EGS patients was low and may be due to the use of non-narcotic adjuncts for pain management. Further studies are needed to understand and optimize pain management strategies for this group of high-risk patients undergoing complex surgical procedures.