Opioid Prescribing Research Articles

The Impact of the COVID-19 Pandemic on Pattern of Antibiotic and Opioid Prescriptions by Dentists in Alberta, Canada.

After the shutdown of most dental services during the COVID-19 lockdown, the oral health community was concerned about an increase in prescribing opioids and antibiotics by dentists due to patients' limited access to dental offices. Therefore, the objective of this study was to investigate the impact of COVID-19 pandemic on the pattern of antibiotic and opioid prescriptions by dentists in Alberta, Canada. Data obtained from the Tracked Prescription Program were divided into antibiotics and opioids. Time periods were outlined as pre-, during-, and postlockdown (phase 1 and 2). For the number of prescriptions and average supply, each monthly average was compared to the corresponding prelockdown monthly average, using descriptive analysis. Time series analyses were conducted using regression analyses with an autoregressive error model. Data were trained and tested on monthly observations before lockdown and predicted for during- and postlockdown. A total of 1.1 million antibiotics and 400,000 opioids dispense were tracked. Decreases in the number of prescriptions during lockdown presented for antibiotics (n = 24,933 vs. 18,884) and opioids (n = 8892 vs. 6051). Average supplies (days) for the antibiotics (n = 7.10 vs. 7.55) and opioids (n = 3.92 vs. 4.05) were higher during the lockdown period. In the trend analyses, the monthly number of antibiotic and opioid prescriptions showed the same pattern and decreased during lockdown. The COVID-19 pandemic altered the trends of prescribing antibiotics and opioids by dentists. The full impact of COVID-19 pandemic on the population's oral health in light of changes in prescribing practices by dentists during and after lockdown warrants further investigation.

Adolescent oral oxycodone self-administration disrupts neurobehavioral and neurocognitive development

Nonmedical use of prescription opioids peaks during late adolescence, a developmental period associated with the maturation of higher-order cognitive processes. To date, however, how chronic adolescent oxycodone (OXY) self-administration alters neurobehavioral (i.e., locomotion, startle reactivity) and/or neurocognitive (i.e., preattentive processes, intrasession habituation, stimulus-reinforcement learning, sustained attention) function has not yet been systematically evaluated. Hence, the rationale was built for establishing the dose-dependency of adolescent OXY self-administration on the trajectory of neurobehavioral and neurocognitive development. From postnatal day (PD) 35 to PD 105, an age in rats that corresponds to the adolescent and young adult period in humans, male and female F344/N rats received access to either oral OXY (0, 2, 5, or 10 mg/kg) or water under a two-bottle choice experimental paradigm. Independent of biological sex or dose, rodents voluntarily escalated their OXY intake across ten weeks. A longitudinal experimental design revealed prominent OXY-induced impairments in neurobehavioral development, characterized by dose-dependent increases in locomotion and sex-dependent increases in startle reactivity. Systematic manipulation of the interstimulus interval in prepulse inhibition supports an OXY-induced impairment in preattentive processes. Despite the long-term cessation of OXY intake, rodents with a history of chronic adolescent oral OXY self-administration exhibited deficits in sustained attention; albeit no alterations in stimulus-reinforcement learning were observed. Taken together, adolescent oral OXY self-administration induces selective long-term alterations in neurobehavioral and neurocognitive development enjoining the implementation of safer prescribing guidelines for this population.

Awareness of the potential consequences of alcohol consumption in the context of chronic pain and prescription opioid use

ABSTRACT Background: Alcohol and prescription opioid use are highly prevalent among chronic pain populations. One-fifth of individuals prescribed opioids report same-day use of alcohol and opioids. Alcohol use and alcohol/opioid co-use can have deleterious pain management and health outcomes. The extent to which individuals with chronic pain are aware of these deleterious outcomes is considerably understudied. Objectives: To explore individuals’ understanding of seven health- and pain-related risks of alcohol/alcohol-opioid use. An exploratory aim was to examine whether greater risk awareness was associated with alcohol/opioid use patterns. Methods: Participants included 261 adults age ≥21(36.4% women) endorsing current alcohol use, chronic musculoskeletal pain, and opioid prescription who completed an online survey via Amazon Mechanical Turk. Results: Distribution of the total number of items for which a participant endorsed awareness was as follows: zero (10.7%), one (5.0%), two (13.0%), three (13.8%), four (13.8%), five (11.5%), six (10.0%), and seven items (22.2%). Awareness of the health consequences of alcohol/alcohol-opioid use was positively associated with opioid misuse behaviors (β = .525, ΔR2 = .251, p < .001), and higher-risk alcohol consumption (β = .152, ΔR2 = .021, p = .011). Conclusion: Many adults with chronic pain are unaware of the health consequences of alcohol/alcohol-opioid use. Findings of positive covariation between risk awareness and higher-risk alcohol/opioid use suggest that future interventions among this population should go beyond simple risk education and utilize motivational enhancement to help change decisional balance.

559 Can Poller Screws Decrease Pain Relief in Femoral Fractures?

Abstract Aim Poller screws, used alongside intramedullary (IM) nails for femoral shaft fractures, aim to expedite healing and minimize complications by enhancing fracture stability and controlling IM nail insertion. Despite their benefits, the impact of poller screws on post-operative pain is understudied. This retrospective cohort study aimed to compare opioid medication needs in femoral shaft fractures managed with IM nails with and without poller screws. Method Between January 2015 and December 2022, a retrospective analysis was conducted on femoral shaft fractures treated at a major trauma centre. Patients primarily treated with IM nails were included. Patient and operation notes, along with radiographs, identified poller screw utilization and categorized screw generation. Opioid medication data, converted to "coverage" (days) and "strength" (morphine milligrams equivalent or MME), was collected. Two-tailed independent samples T-tests compared patients treated with (n=43) and without poller screws (n=364). Results Second-generation poller screws significantly reduced opioid strength requirements in the first post-operative year (603.6 vs. 1711.6 MME, p=0.03), except the first month. However, no significant difference was observed in the number of days with opioid prescriptions throughout the first post-operative year for each poller screw generation. Conclusions This study highlights the potential of poller screws in reducing post-operative pain in femoral fractures. Future endeavors aim to use a larger patient sample, but these results signify the promise of poller screws in mitigating post-operative pain in IM-treated femoral fractures.

Diagnosing and managing prescription opioid use disorder in patients prescribed opioids for chronic pain in Australian general practice settings: a qualitative study using the theory of Planned Behaviour

BackgroundChronic pain is a debilitating and common health issue. General Practitioners (GPs) often prescribe opioids to treat chronic pain, despite limited evidence of benefit and increasing evidence of harms, including prescription Opioid Use Disorder (pOUD). Australian GPs are worried about the harms of long-term opioids, but few are involved in the treatment of pOUD. There is little research on GPs’ experiences diagnosing and managing pOUD in their chronic pain patients.MethodsThis qualitative research used semi-structured interviews and a case study to investigate GPs’ experiences through the lens of the Theory of Planned Behaviour (TPB). TPB describes three factors, an individual’s perceived beliefs/attitudes, perceived social norms and perceived behavioural controls. Participants were interviewed via an online video conferencing platform. Interviews were transcribed verbatim and thematically analysed.ResultsTwenty-four GPs took part. Participants were aware of the complex presentations for chronic pain patients and concerned about long-term opioid use. Their approach was holistic, but they had limited understanding of pOUD diagnosis and suggested that pOUD had only one treatment: Opioid Agonist Treatment (OAT). Participants felt uncomfortable prescribing opioids and were fearful of difficult, conflictual conversations with patients about the possibility of pOUD. This led to avoidance and negative attitudes towards diagnosing pOUD. There were few positive social norms, few colleagues diagnosed or managed pOUD. Participants reported that their colleagues only offered positive support as this would allow them to avoid managing pOUD themselves, while patients and other staff were often unsupportive. Negative behavioural controls were common with low levels of knowledge, skill, professional supports, inadequate time and remuneration described by many participants. They felt OAT was not core general practice and required specialist management. This dichotomous approach was reflected in their views that the health system only supported treatment for chronic pain or pOUD, not both conditions.ConclusionsNegative beliefs, negative social norms and negative behavioural controls decreased individual behavioural intention for this group of GPs. Diagnosing and managing pOUD in chronic pain patients prescribed opioids was perceived as difficult and unsupported. Interventions to change behaviour must address negative perceptions in order to lead to more positive intentions to engage in the management of pOUD.

The association between primary care appointment lengths and opioid prescribing for common pain conditions

BackgroundWhile brief duration primary care appointments may improve access, they also limit the time clinicians spend evaluating painful conditions. This study aimed to evaluate whether 15-minute primary care appointments resulted in higher rates of opioid prescribing when compared to ≥ 30-minute appointments.MethodsWe performed a retrospective cohort study using electronic health record (EHR), pharmacy, and administrative scheduling data from five primary care practices in Minnesota. Adult patients seen for acute Evaluation & Management visits between 10/1/2015 and 9/30/2017 scheduled for 15-minute appointments were propensity score matched to those scheduled for ≥ 30-minutes. Sub-groups were analyzed to include patients with acute and chronic pain conditions and prior opioid exposure. Multivariate logistic regression was performed to examine the effects of appointment length on the likelihood of an opioid being prescribed, adjusting for covariates including ethnicity, race, sex, marital status, and prior ED visits and hospitalizations for all conditions.ResultsWe identified 45,471 eligible acute primary care visits during the study period with 2.7% (N = 1233) of the visits scheduled for 15 min and 98.2% (N = 44,238) scheduled for 30 min or longer. Rates of opioid prescribing were significantly lower for opioid naive patients with acute pain scheduled in 15-minute appointments when compared to appointments of 30 min of longer (OR 0.55, 95% CI 0.35–0.84). There were no significant differences in opioid prescribing among other sub-groups.ConclusionsFor selected indications and for selected patients, shorter duration appointments may not result in greater rates of opioid prescribing for common painful conditions.

Preoperative vs Postoperative Opioid Prescriptions and Prolonged Opioid Refills Among US Youths

High-risk practices, including dispensing an opioid prescription before surgery when not recommended, remain poorly characterized among US youths and may contribute to new persistent opioid use. To characterize changes in preoperative, postoperative, and refill opioid prescriptions up to 180 days after surgery. This retrospective cohort study was performed using national claims data to determine opioid prescribing practices among a cohort of opioid-naive youths aged 11 to 20 years undergoing 22 inpatient and outpatient surgical procedures between 2015 and 2020. Statistical analysis was performed from June 2023 to April 2024. The primary outcome was the percentage of initial opioid prescriptions filled up to 14 days prior to vs 7 days after a procedure. Secondary outcomes included the likelihood of a refill up to 180 days after surgery, including refills at 91 to 180 days, as a proxy for new persistent opioid use, and the opioid quantity dispensed in the initial and refill prescriptions in morphine milligram equivalents (MME). Exposures included patient and prescriber characteristics. Multivariable logistic regression models were used to estimate the association between prescription timing and prolonged refills. Among 100 026 opioid-naive youths (median [IQR] age, 16.0 [14.0-18.0] years) undergoing a surgical procedure, 46 951 (46.9%) filled an initial prescription, of which 7587 (16.2%) were dispensed 1 to 14 days before surgery. The mean quantity dispensed was 227 (95% CI, 225-229) MME; 6467 youths (13.8%) filled a second prescription (mean MME, 239 [95% CI, 231-246]) up to 30 days after surgery, and 1216 (3.0%) refilled a prescription 91 to 180 days after surgery. Preoperative prescriptions, increasing age, and procedures not typically associated with severe pain were most strongly associated with new persistent opioid use. In this retrospective study of youths undergoing surgical procedures, of which, many are typically not painful enough to require opioid use, opioid dispensing declined, but approximately 1 in 6 prescriptions were filled before surgery, and 1 in 33 adolescents filled prescriptions 91 to 180 days after surgery, consistent with new persistent opioid use. These findings should be addressed by policymakers and communicated by professional societies to clinicians who prescribe opioids.

The effectiveness of opioid stewardship interventions in healthcare: A Making Healthcare Safer rapid review

Objective Opioid stewardship interventions promote appropriate use of opioids. We synthesized evidence from recent studies on the effectiveness of opioid stewardship interventions in United States healthcare settings on opioid prescribing and clinical outcomes. Methods We followed the Evidence-based Practice Center Program's rapid review processes. We searched PubMed and Cochrane for original studies meeting specified inclusion criteria from January 2016 (correlating with the Centers for Disease Control and Prevention Pain Guidelines) to April 2023, supplemented by gray literature searches. Findings Our search identified 13 randomized controlled trials and 6 nonrandomized studies. Randomized controlled trials addressed interventions involving multiple components (typically combining prescriber education, care management, and facilitated access to resources), clinical decision support (CDS) or electronic health records (EHR), and patient education and engagement, mainly in ambulatory chronic pain. Multicomponent interventions and opioid stewardship practices involving CDS or EHR were associated with decreased opioid prescribing or reduced doses and no increases in pain, emergency department visits, or hospitalizations (low strength of evidence for all outcomes). Patient engagement and education interventions had mixed results for opioid prescribing outcomes (insufficient strength of evidence) and no increases in pain, emergency department visits, or hospitalizations (low strength of evidence). Conclusions Selected opioid stewardship interventions may be effective for reducing opioid prescribing without adversely affecting clinical outcomes. Interventions to reduce opioid prescribing should monitor unintended consequences and include access to nonpharmacological pain management resources with patient education and engagement.

Improving Naloxone Co-prescribing Through Clinical Decision Support.

Despite national guidelines recommending naloxone co-prescription with high-risk medications, rates remain low nationally.This was reflected atour institution with remarkably low naloxone prescribing rates.We sought to determine if a clinical decision support (CDS) tool could increase rates of naloxone co-prescribing with high-risk prescriptions. An alert in the electronic health record was triggered upon signing an order for a high-risk opioid medication without a naloxone co-prescription.We examined all opioid prescriptions written by family and general internal medicine practitioners at the University of Iowa Hospitals and Clinics in outpatient encounters between November 30, 2020, and February 28, 2022.Once triggered by a high-risk prescription, the CDS tool had the option to choose an order set with an automatically selected co-prescription for naloxone along with patient instructions automatically added to the patient's after-visit summary (AVS).We examined the monthly percentage of patients receiving Schedule II opioid prescriptions ≥90 morphine milliequivalents (MME)/day who received concurrent naloxone prescriptions in the 12 months before the CDS went live and the three months following go-live. Concurrent naloxone prescriptions increased from 1.1% in the 12 months prior to implementation in November 2021 to 9.4% (p<0.001) during the post-intervention period across eight family medicine and internal medicine clinics. This single-center quality improvement project with retrospective analysis demonstrates the potential efficacy of a single CDS tool in increasing the rate of naloxone prescription.The impact of such prescribing on overall mortality requires further research. The CDS tool was easy to implement and improved rates of appropriate naloxone co-prescribing.

Opioid and non-opioid analgesic regimens after fracture and risk of serious opioid-related events

BackgroundNon-opioid analgesics are prescribed in combination with opioids among patients with long bone fracture to reduce opioid prescribing needs, yet evidence is limited on whether they reduce the risk of...

How Should the Use of Opioids Be Regulated to Motivate Better Clinical Practice?

This article describes historical and political reasons for-and devastating consequences of-US opioid prescribing policy since the 1990s, which has restricted opioid prescribing for pain less than for treating opioid use disorder (OUD) treatment. This article considers merits and drawbacks of a new diagnostic category and proposes a regulatory and clinical framework for prescribing long-term opioid therapy for pain and for prescribing opioids to treat OUD.

Navigating opioid use in chronic noncancer pain conditions: A case series on pseudoaddiction.

Opioid prescriptions for chronic non-cancer pain raise concerns of addiction risks. Understanding the nuanced intersection of chronic pain and opioid use is crucial in clinical settings. We present four case studies from two tertiary care hospitals illustrating the phenomenon of "pseudoaddiction" in CNCP referred to addiction specialists for management. Each case involves complex pain presentations like pancreatitis, avascular necrosis, and SLE intertwined with escalating opioid demands. Management involved psychoeducation, CBT, and opioid substitution, resulting in reduced pain and need for opioids. Differentiating between addiction and uncontrolled pain is crucial for tailored management, emphasizing individualized care for improved outcomes.

Impact of automated alerts on discharge opioid overprescribing after general surgery

Abstract Purpose The objectives of this study were to identify the most performed surgical procedures associated with the highest rates of discharge opioid overprescribing and to implement an electronic health record (EHR) alert to reduce discharge opioid overprescribing. Methods This quality improvement, before-and-after study included patients undergoing one of the identified target procedures—laparoscopic cholecystectomy, unilateral open inguinal hernia repair, and laparoscopic appendectomy—at an academic medical center. The alert notified providers when the prescribed opioid quantity exceeded guideline recommendations. The preimplementation cohort included surgical encounters from January 2020 to December 2021. The EHR alert was implemented in May 2022 following provider education via email and in-person presentations. The postimplementation cohort included surgical encounters from May to August 2022. The primary outcome was the proportion of patients with a discharge opioid supply exceeding guideline recommendations (overprescribing). Results A total of 1,478 patients were included in the preimplementation cohort, and 141 patients were included in the postimplementation cohort. The proportion of patients with discharge opioid overprescribing decreased from 48% in the preimplementation cohort to 3% in the postimplementation cohort, with an unadjusted absolute reduction of 45% (95% confidence interval, 41% to 49%; P &amp;lt; 0.001) and an adjusted odds ratio of 0.03 (95% confidence interval, 0.01 to 0.08; P &amp;lt; 0.001). Among patients who received opioids, the mean (SD) opioid supply at discharge decreased from 92 (43) oral morphine milligram equivalents (MME) (before implementation) to 57 (20) MME (after implementation) (P &amp;lt; 0.001). The proportion of patients who received additional opioid prescriptions within 1 to 14 days following hospital discharge did not change (P = 0.76). Conclusion Implementation of an EHR alert along with provider education can reduce discharge opioid overprescribing following general surgery.

Intergroup time bias and aversive racism in the medical context.

Time is fundamental to organizing all aspects of human life. When invested in relationships, it has a psychological meaning as it indicates how much individuals value others and their interest in maintaining social relationships. Previous research has identified an intergroup time bias (ITB) in racialized social relations, defined as a discriminatory behavior in which White individuals invest more time in evaluating White than Black individuals. This research proposes an aversive racism explanation for the ITB effect and examines its consequences in the medical context. In four experimental studies (N = 434), we found that White medical trainees invested more time in forming impressions of White (vs. Black) male patients. Study 5 (N = 193) further revealed more time investment in diagnosing, assessing pain, and prescribing opioids for White than Black male patients. This biased time effect mediated the impact of patients' skin color on health care outcomes, leading to greater diagnostic accuracy and pain perception, and lower opioid prescriptions. A meta-analytical integration of the results (Study 6) confirmed the ITB effect reliability across experiments and that it is stronger in participants with an aversive racist profile (vs. consistently prejudiced or nonprejudiced). These findings provide the first evidence that bias in time investment favoring White (vs. Black) patients is associated with aversive racism and impacts medical health care outcomes. Furthermore, these results offer insights into the sociopsychological meaning of time investment in health care and provide a theoretical explanation for an understudied insidious form of discrimination that is critical to comprehending the persistency of racial health care disparities. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Heavy Versus Light Smoking: Its Association With Opioid Use, Chronic Pain, and Mental Health

There is much concern that substance use treatment programs are rarely integrated with smoking cessation programs. Here, the first national statistics are presented on the connection between heavy vs. light smoking and the opioid epidemic. Using the 2013-2021 Medical Expenditure Panel Survey linked to the National Health Interview Survey, N=81,400 adults-years, logit regressions estimate the impact of heavy vs. light smoking on opioid use, chronic pain, work limitations due to pain, and poor mental health. Analyses were conducted from October 2023 to May 2024. Only 37 percent of the population has ever smoked, but they used 69% of the nation's annual prescription opioids. Adults who smoked more than 5 cigarettes a day composed 12% of the population but used about the same number of opioids as the 63% of the population who never smoked. Adults who formerly smoked used 16% fewer opioids than adults who currently smoke (p<0.01). The percent with chronic pain during the year varied from 12.2% for adults who never smoked to 14.2% for light smoking, to 16.5% for those smoking more than a pack a day (p<0.01). Severe work limitations due to pain varied from 7.3% for adults who never smoked to 16.9% for those smoking more than a pack a day (p<0.01). Adults smoking more than a pack a day were twice as likely to report fair or poor mental health compared to those who never smoked (29.2% vs 13.6%) (p<0.01). As nations deal with the opioid epidemic, integrating smoking cessation programs into substance abuse treatment programs appears prudent.

Substance Use–Related Alterations of Social Decision Making in a Longitudinal Cohort of Young Adults

BackgroundSubstance use disorders are associated with severe negative social and health-related outcomes. Evidence has accumulated that long-term substance use is associated with alterations in social interaction behavior, which likely contributes to the vicious cycle of substance use disorder. However, little is known about whether these social problems originate from contextual factors only or also from the substance use itself—in other words, if they are predisposed or substance induced. MethodsWe studied the causation behind behavioral alterations of substance users over a 9-year period (ages 11–20 years) in an urban age cohort (N = 1002) with a high prevalence of substance use at age 20. We identified common substance use patterns using toxicological hair analysis, examined behavioral alterations with incentivized games, and used teacher assessments across different ages to determine the causes and effects that underlie substance use–related impairments in social interaction. ResultsWe found that opioid and stimulant users showed reduced prosocial behavior compared with nonusers, particularly in interpersonal trust and perspective taking (e.g., they were approximately 50% less likely to trust others). Our longitudinal analyses suggest a causal relationship between the nonmedical use of prescription opioids and impaired social behavior, whereas impairments among stimulant users seem to be partially predisposed. Moreover, women tended to be more severely affected by opioid use than men. However, no behavioral alterations were found among young adult cannabis or ecstasy users. ConclusionsHighly addictive substances such as opioids can impair users’ social behavior by undermining fundamental human interaction, thereby fueling a vicious cycle of substance use and social isolation.

Pain Management Treatments and Opioid Use Disorder Risk in Medicaid Patients

IntroductionPeople with chronic pain are at increased risk of opioid-misuse. Less is known about the unique risk conferred by each pain management treatment, as treatments are typically implemented together, confounding their independent effects. This study estimated the extent to which pain management treatments were associated with risk of opioid use disorder (OUD) for those with chronic pain, controlling for baseline demographic and clinical confounding variables and holding other pain management treatments at their observed levels. MethodsData were analyzed in 2024 from two chronic pain subgroups within a cohort of non-pregnant Medicaid patients aged 35-64 years, 2016-2019, from 25 states: those with 1) chronic pain and physical disability (CPPD) (N=6,133) or 2) chronic pain without disability (CP) (N=67,438). Nine pain management treatments were considered: prescription opioid i) dose and ii) duration; iii) number of opioid prescribers; opioid co-prescription with iv) benzo- diazepines, v) muscle relaxants, and vi) gabapentinoids; vii) non-opioid pain prescription, viii) physical therapy, and ix) other pain treatment modality. The outcome was OUD risk. ResultsHaving opioids co-prescribed with gabapentin or benzodiazepine was statistically significantly associated with a 37-45% increased OUD risk for the CP subgroup. Opioid dose and duration also were significantly associated with increased OUD risk in this subgroup. Physical therapy was significantly associated with an 18% decreased risk of OUD in the CP subgroup. ConclusionsCo-prescription of opioids with either gabapentin or benzodiazepines may substantially increase OUD risk. More positively, physical therapy may be a relatively accessible and safe pain management strategy.

Use of Muscle Relaxants After Surgery in Traditional Medicare Part D Enrollees.

Surgeons have come under increased scrutiny for postoperative pain management, particularly for opioid prescribing. To decrease opioid use but still provide pain control, nonopioid medications such as muscle relaxants are being used, which can be harmful in older adults. However, the prevalence of muscle relaxant prescribing, trends in use over time, and risk of prolonged use are unknown. Using a 20% representative Medicare sample, we conducted a retrospective analysis of muscle relaxant prescribing to patients ≥ 65 years of age. We merged patient data from Medicare Carrier, MedPAR, and Outpatient Files with Medicare Part D for the years 2013-2018. A total of 14 surgical procedures were included to represent a wide range of anatomic regions and specialties. The study cohort included 543,929 patients. Of the cohort, 8111 (1.5%) received a new muscle relaxant prescription at discharge. Spine procedures accounted for 12% of all procedures but 56% of postoperative prescribing. Overall, the rate of prescribing increased over the time period (1.4-2.0%, p < 0.001), with increases in prescribing primarily in the spine (7-9.6%, p < 0.0001) and orthopedic procedure groups (0.9-1.4%, p < 0.0001). Of patients discharged with a new muscle relaxant prescription, 10.7% had prolonged use. The use of muscle relaxants in the postoperative period for older adults is low, but increasing over time, especially in ortho and spine procedures. While pain control after surgery is crucial, surgeons should carefully consider the risks of muscle relaxant use, especially for older adults who are at higher risk for medication-related problems.

858 Post Operative Opioid Prescribing in Patients Undergoing Primary Elective Total Hip Replacement (THR): A Closed-Loop Clinical Audit

858 Post Operative Opioid Prescribing in Patients Undergoing Primary Elective Total Hip Replacement (THR): A Closed-Loop Clinical Audit

Patient reported opioid usage following vulvar surgery in gynecologic oncology

BackgroundThere remains a paucity of data for vulvar surgery outcomes in gynecologic oncology in the era of Enhanced Recovery After Surgery (ERAS) ®. As such, the primary objective is to assess the impact of patient and procedural factors on patient reported postoperative opioid usage following vulvar surgery. Secondary objective is to create a tailored opioid prescribing algorithm for this population. MethodsA retrospective cohort study was performed of patients who underwent vulvar surgery for a gynecologic malignancy between 3/2019–7/2022. Covariates of interest included a history of risk factors for opioid usage, age, anatomic location of the vulvar resection, radicality of surgery, groin dissection, use of postoperative non-steroidal anti-inflammatory drugs (NSAIDs), and complications. Logistic regression models evaluated the effects that sociodemographic characteristics and procedural factors have on opioid usage. Linear regression models were created to determine prescribing guidelines. ResultsA total of 100 patients were included. Following surgery, 35 patients (35 %) were not sent home with an opioid prescription, 39 patients (39 %) reported using at least one opioid pill from their prescription, and 26 patients (26 %) reported not using any opioid pills from their prescription. In the regression models, patient age (p < 0.006) had a significant impact on opioid use, while all other factors did not. Contraindications to NSAIDs did not have a statistically significant impact (p = 0.1) but was deemed clinically meaningful and included in the final model. Proposed opioid prescribing guidelines were created. ConclusionIn conclusion, most patients after vulvar surgery require little to no opioids. Identifiable preoperative factors can aid providers to manage postoperative pain while minimizing unnecessary opioid prescriptions.