The Use of Opioid Analgesia after Surgery: Assessing Postoperative Prescriptions from a Patient and Surgeon Perspective

Abstract

Purpose: Nonmedical use of prescription opioids continues to be a public health crisis in the United States that disproportionately affects rural communities with diversion of pills from friends and family being the most common source. The primary goal of the study was to identify current opioid prescription practices, and to assess the discrepancy in amount of opioids prescribed by surgeons versus the amount needed post-operatively by patients. Patient factors that may influence postoperative analgesia needs and their management of leftover prescription opioids were also evaluatedMethods: Patients ≥18 years-of-age who underwent a surgery between July and December 2018 by the subspecialty departments of Acute Care and General Surgery at a tertiary care facility in the rural Midwest were surveyed at their first post-operative visit to assess their postoperative analgesic needs. Resident and attending surgeons in the above departments were also surveyed to identify different factors that influenced their narcotic prescription practices.Results: Surveys from 252 patients, 12 attending surgeons, and 14 general surgery residents met inclusion criteria. Of patients who received a narcotic prescription, 19.9% did not fill their prescription, 64.1% of whom were >60 years old, and 72.1% resided within an hour of the hospital. Average reported prescription size was 11-40 pills; however, most used more than 5 pills regardless of the type of operation (P=0.59) and history of chronic pain (P=0.07). Inability to call in narcotic prescriptions and patients' distance from care influenced providers' prescription practices, with 77.9% of resident physicians and 68.3% of attending surgeons stating they would prescribe fewer if given the ability to call in a narcotic prescription.Conclusions: Regardless of the operation complexity, a majority of patients required fewer than five opioid pills after discharge and would be willing to return leftover pills. Development of opioid stewardship programs within the healthcare sector may reduce the number of opioids available for diversion and misuse.