Postoperative Opioid Prescribing Research Articles

Opioid-Free Discharge is Not Associated With Increased Unplanned Healthcare Encounters After Ureteroscopy: Results From a Statewide Quality Improvement Collaborative

ObjectivesTo evaluate patient factors associated with post-ureteroscopy opioid prescriptions, provider-level variation in opioid prescribing, and the relationship between opioid-free discharges and ED visits. MethodsThis is a retrospective analysis of a prospective cohort study of adults age 18 years and older who underwent primary ureteroscopy for urinary stones from June 2016 to September 2019 within the Michigan Urological Surgery Improvement Collaborative (MUSIC) Reducing Operative Complications from Kidney Stones (ROCKS) quality improvement initiative. Postoperative opioid prescription trends and variation among practices and surgeons were examined. Multivariable logistic regression models defined risk factors for receipt of opioid prescriptions. The association among opioid prescriptions and postoperative ED visits within 30 days of surgery was assessed among complete case and propensity matched cohorts, matched on all measured characteristics other than opioid receipt. Results13,143 patients underwent ureteroscopy with 157 urologists across 28 practices. Post-ureteroscopy opioid prescriptions and ED visits declined (86% to 39%, P<.001; 10% to 6%, P<.001, respectively). Practice and surgeon-level opioid prescribing varied from 8% to 98%, and 0% to 98%, respectively. Patient-related factors associated with opioid receipt included male, younger age, and history of chronic pain. Procedure-related factors associated with opioid receipt included pre- and post-ureteroscopy ureteral stenting and access sheath use. An opioid-free discharge was not associated with increased odds of an ED visit (OR 0.77, 95% CI 0.62-0.95, P=.014). ConclusionsThere was no increase in ED utilization among those not prescribed an opioid after ureteroscopy, suggesting their routine use may not be necessary in this setting.

MP47-02 ELIMINATING OPIOIDS IN OUTPATIENT PEDIATRIC SURGERY

You have accessJournal of UrologyPediatric Urology III (MP47)1 Sep 2021MP47-02 ELIMINATING OPIOIDS IN OUTPATIENT PEDIATRIC SURGERY Matthew Sims, Paige Hargis, and Elizabeth Malm-Buatsi Matthew SimsMatthew Sims More articles by this author , Paige HargisPaige Hargis More articles by this author , and Elizabeth Malm-BuatsiElizabeth Malm-Buatsi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002068.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In recent years, use of opioid prescriptions has undergone increasing scrutiny worldwide. In the pediatric urology population, there has been limited research on decreasing post-operative opioid prescriptions, but no studies utilize a zero-opioid approach. We recently performed a retrospective study of 242 patients at our institution, in which no patient received opioids at discharge. Only 2.1% called about post-op pain. In this prospective study, we aim to assess eliminating opioids in postoperative pain control as part of a multimodal approach in pediatric patients undergoing same-day urologic surgery. METHODS: After IRB approval was obtained, patients aged 6 months to 12 years-old undergoing common outpatient urologic procedures were treated with a multimodal approach for post-op pain management that did not include narcotics. This did involve comprehensive parent education, intra-operative local anesthesia, ice packs, bacitracin ointment for penile cases, and acetaminophen and ibuprofen prescriptions at discharge. Parents were contacted on post-op day (POD) 2 and POD7 to inquire about the child’s pain and parent satisfaction. To assess pain, we used validated pain surveys: Parents’ Post-operative Pain Measure (PPPM) for children over 2 years and the Face-Legs-Activity-Cry-Consolability (FLACC) for children under 2 years. Parent satisfaction regarding pain control, prescription practices, and expectations was evaluated with a Likert scale. RESULTS: 120 patients were included in the study from March to November 2020. We received responses from parents of 95 patients (79.2% response rate). On POD2, 6/95 (6.3%) patients had clinically significant pain, as determined by responses to PPPM or FLACC. 7 days after surgery, 2/92 (2.2%) reported clinically significant pain. However, those two patients had pain not directly related to the surgical site: a diaper rash in one patient and the other patient with urethral pain from accidental catheter pull. None of our patients ever required narcotic pain medications. Average parent satisfaction with pain control was 4.86/5.0. CONCLUSIONS: We found that post-op pain in pediatric patients undergoing outpatient urologic surgery can be successfully managed without opioid pain medication and with excellent parent satisfaction. This is the first study of its kind to assess zero-opioid prescribing in this patient population and should give pediatric urologic surgeons the confidence needed to forego narcotics in these patients. This approach is successful when coupled with a comprehensive parent education, expectation management, and multi-modal therapy. Source of Funding: none © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e823-e823 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Matthew Sims More articles by this author Paige Hargis More articles by this author Elizabeth Malm-Buatsi More articles by this author Expand All Advertisement Loading ...

Effect of narcotic prescription limiting legislation on opioid utilization following pediatric spinal fusion for scoliosis.

Since 2016, 35 of 50 US states have approved opioid-limiting and monitoring laws. The impact on postoperative opioid prescribing and secondary outcomes following pediatric scoliosis deformity correction surgery remains unknown. To evaluate the effect of CURES 2.0 opioid-limiting regulations on postoperative opioid prescriptions and unplanned readmissions following pediatric scoliosis deformity correction surgery. Retrospective review of prospectively collected data. Two patient cohorts (pre-CURES January 1, 2017-October 22, 2018 and post-CURES September 1, 2018-May 30, 2020) that included all patients undergoing pediatric scoliosis deformity surgery at a single institution. Demographic, medical, surgical, clinical, and pharmacological data was collected from all patients. Total morphine milligram equivalents (MMEs) prescribed was compared at 30-day postoperative intervals. Readmission rates were calculated. Categorical variables were evaluated with Chi squared analysis and continuous variables were evaluated with t test or Mann-Whitney U test as appropriate. Logistic regression was used to evaluate risk factors for increased postoperative opioid. Of 108 identified patients, 94 (49 pre-CURES, 45 post-CURES) were included in the study. Post-CURES patients were older (p = 0.001). All other demographic, medical, and surgical factors were similar between pre-CURES and post-CURES patients (all p > 0.05). Post-CURES, patients received fewer pills in their first postoperative prescription (43.4 vs. 57.4 pills, p = 0.006), less opioids (MMEs) during the first 0 to 30-day and 31 to 60-day postoperative intervals (261.8 MMEs vs. 337.6 MMEs, p = 0.028 and 17.8 MMEs vs. 59.7 MMEs, p = 0.016, respectively). Increased 120-day opioid utilization was associated with surgery in the pre-CURES period, age, BMI, and decreased number of levels fused (all p < 0.05). Postoperative readmission within 90days was associated with age, BMI, number of levels fused, and length of stay. Implementation of CURES 2.0 has resulted in a reduction in the opioid prescription following pediatric scoliosis deformity surgery without an increase in readmissions. Further studies are needed to evaluate how legislations of this kind affect patient reported outcomes, satisfaction, and quality of life.

High-risk Opioid Prescribing Associated with Postoperative New Persistent Opioid Use in Adolescents and Young Adults.

In this study, we explored which postoperative opioid prescribing practices were associated with persistent opioid use among adolescents and young adults. Approximately 5% of adolescents and young adults develop postoperative new persistent opioid use. The impact of physician prescribing practices on persistent use among young patients is unknown. We identified opioid-naïve patients aged 13 to 21 who underwent 1 of 13 procedures (2008-2016) and filled a perioperative opioid prescription using commercial insurance claims (Optum Deidentified Clinformatics Data Mart Database). Persistent use was defined as ≥ 1 opioid prescription fill 91 to 180 days after surgery. High-risk opioid prescribing included overlapping opioid prescriptions, co-prescribed benzodiazepines, high daily prescribed dosage, long-acting formulations, and multiple prescribers. Logistic regression modeled persistent use as a function of exposure to high-risk prescribing, adjusted for patient demographics, procedure, and comorbidities. High-risk opioid prescribing practices increased from 34.9% to 43.5% over the study period; the largest increase was in co-prescribed benzodiazepines (24.1%-33.4%). High-risk opioid prescribing was associated with persistent use (aOR 1.235 [1.12,1.36]). Receipt of prescriptions from multiple opioid prescribers was individually associated with persistent use (aOR 1.288 [1.16,1.44]). The majority of opioid prescriptions to patients with persistent use beyond the postoperative period were from nonsurgical prescribers (79.6%). High-risk opioid prescribing practices, particularly receiving prescriptions from multiple prescribers across specialties, were associated with a significant increase in adolescent and young adult patients' risk of persistent opioid use. Prescription drug monitoring programs may help identify young patients at risk of persistent opioid use.

Long-term opioid use in seniors following hip and knee arthroplasty in Ontario: a historical cohort study.

Canadian seniors who undergo hip and knee arthroplasty often experience significant postoperative pain, which could result in persistent opioid use. We aimed to document the impact of preoperative opioid use and other characteristics on postoperative opioid prescriptions in elderly patients following hip and knee replacement before widespread dissemination of opioid reduction strategies. We conducted a historical cohort study to evaluate postoperative opioid use in patients over 65 yr undergoing primary total hip and knee replacement over a ten-year period from 1 April 2006 to 31 March 2016, using linked de-identified Ontario administrative data. We determinedthe useof preoperative opioids and the duration of postoperative opioid prescriptions (short-term [1-90 days], prolonged [91-180 days], chronic [181-365 days], or undocumented). The study included 49,638 hip and 85,558 knee replacement patients. Eighteen percent of hip and 21% of knee replacement patients received an opioid prescription within 90 days before surgery. Postoperatively, 51% of patients filled opioid prescriptions for 1-90 days, while 24% of hip and 29% of knee replacement patients filled prescriptions between 6 and 12 months, with no impact of preoperative opioid use. Residence in long-term care was a significant predictor of chronic opioid use (hip: odds ratio [OR], 2.64; 95% confidence interval [CI], 1.93 to 3.59; knee: OR, 2.46; 95% CI, 1.75 to 3.45); other risk factors included female sex and increased comorbidities. Despite a main goal of joint arthroplasty being relief of pain, seniors commonly remained on postoperative opioids, even if not receiving opioids before surgery. Opioid reduction strategies need to be implemented at the surgical, primary physician, long-term care, and patient levels. These findings form a basis for future investigations following implementation of opioid reduction approaches.

Effects of State Law Limiting Postoperative Opioid Prescription in Patients After Cesarean Delivery

(Anesth Analg. 2021;132:752–760) Opioids are routinely prescribed following cesarean delivery in the United States, though 1 in 300 of these patients experience new-onset persistent opioid use. As the duration of opioid prescriptions is the strongest indicator of persistent opioid use, the State of Florida passed a law restricting the duration of opioid prescriptions for acute pain to 3 days. Prescriptions may be extended to 7 days if the prescriber documents medical necessity. Studies have been conducted examining the effects of these laws on the general surgery population, there is a lack of studies specifically exploring the impact on cesarean delivery patients. This study aimed to examine the impact of this law, HB 21, on discharge opioid prescription practices in patients undergoing cesarean delivery.

Opioid Prescribing Habits and Pain Management Among Aesthetic Plastic Surgeons.

The opioid epidemic continues to worsen in the USA. Post-operative opioid prescriptions contribute to development of opioid use disorders, with studies showing 6% of plastic surgery patients developing new persistent use. Prescribing by surgeons is often excessive, and plastic surgery patients only consume about half of their opioid prescriptions. To date, most studies that investigate post-operative opioid prescribing rely on examining patterns of opioid fills after surgery using administrative claims data, which exclude the overwhelming majority of aesthetic surgeries. The purpose of this study is to investigate opioid prescribing habits amongst aesthetic plastic surgeons. A 20-items survey were sent out to the Aesthetic Society. The survey focussed on general pain management techniques, as well as specific opioid prescribing patterns for several common aesthetic surgeries. A total of 291 completed surveys were returned. Respondents were asked about opioid prescribing patterns for several common aesthetic surgeries. Surgeons were most likely to prescribe opioids for post-operative pain control for abdominoplasty (91%). Opioids were least likely to be prescribed for blepharoplasty (58%). For studied surgeries, the number of pills prescribed ranged from 2 to 120 pills per procedure. 45% of respondents reported being concerned that the opioid prescriptions they provide contribute to the development of an opioid use disorder. Aesthetic plastic surgeons vary widely in their opioid prescribing. Additionally, a significant number are concerned that prescriptions they provide contribute to development of opioid use disorders. This study demonstrates the need to work towards optimizing and standardizing pain management techniques in aesthetic patients. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

P67. Does a high postoperative opioid dose predict chronic use after ACDF?

<h3>BACKGROUND CONTEXT</h3> Currently there is an incomplete understanding of the patient level risk factors for chronic opioid use after anterior cervical discectomy and fusion (ACDF). Postoperative opioid prescriptions in spine surgery have been found to commonly exceed the dose necessary for return to function and pain relief, however the direct relationship between postsurgical opioid dose and chronic opioid abuse has yet to be explored. <h3>PURPOSE</h3> To determine if increased postoperative prescription opioid dosing is an isolated predictor of chronic opioid use after ACDF. <h3>STUDY DESIGN/SETTING</h3> Retrospective Cohort Analysis. <h3>PATIENT SAMPLE</h3> All patients over age 18 who underwent one- to four-level primary or revision ACDF for cervical spondylosis associated with radiculopathy and/or myelopathy at an academic center between 2016- 2019 were retrospectively identified. Patients lacking descriptive data or opioid utilization records or who had surgery performed for trauma, infection, or malignancy were excluded. <h3>OUTCOME MEASURES</h3> Postoperative opioid use prescription metrics: mean morphine equivalent (MME) opioid dose, duration of usage, and the number of prescriptions and pharmacies utilized. Preoperative opioid and benzodiazepine tolerance. Chronicity of postoperative opioid use. <h3>METHODS</h3> Pre- and postsurgical opioid and benzodiazepine prescriptions, including the postoperative peak MME and duration of use, were obtained from the Pennsylvania Prescription Drug Monitoring Program (PDMP). Univariate analysis compared patient demographics and surgical factors across two binary groups of high vs low postoperative opioid dose (high: MME≥ 90, low: MME< 90) and chronic vs short-term opioid use (chronic: ≥120 days or >10 prescriptions). The relationship between chronic opioid use and patterns of immediate postoperative opioid use was evaluated. Binary logistic regressions were created to identify patient specific predictors of high opioid dose and chronic use. <h3>RESULTS</h3> A total of 385 patients met the inclusion criteria. Preoperative opioid tolerance and history of tobacco use were found to be associated with both high postoperative opioid dose and chronic postoperative usage. In addition, younger age correlated with receiving high dose prescriptions and obesity and preoperative benzodiazepine use were associated with chronic opioid use patterns. Chronicity of postoperative opioid use correlated meaningfully with immediate postoperative opioid use metrics including high single prescription dose, change in opioid prescribed, private pay scripatients, and greater than one prescriber and pharmacy. High postoperative opioid dose and preoperative opioid tolerance were identified as isolated predictors of chronic postsurgical opioid use on logistic regression. Regression also determined younger age, increased medical comorbidities, and opioid tolerance were significant predictors for high MME prescriptions. <h3>CONCLUSIONS</h3> High postoperative opioid dose was found to be a significant predictor of chronic opioid use after ACDF regardless of preoperative opioid tolerance. Because a multitude of factors increase patient opioid dose requirements after surgery, further research is required to determine if there exists a causal relationship between high postoperative opioid dosing and chronicity of use. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

P71. Low dose versus high dose opioid prescriptions in addition to non-opiate analgesics in opioid naïve patients undergoing spine surgery

<h3>BACKGROUND CONTEXT</h3> Medically prescribed opiates contribute to the opioid crisis, manifesting in significant mortality and economic burden. While opioids are a mainstay of pain amelioration, prescription practices among surgeons are heterogenous. This study sought to investigate the relationship between immediate postoperative opioid prescriptions and patient reported pain outcomes following spinal surgery. <h3>PURPOSE</h3> To investigate the relationship between immediate postoperative opioid prescriptions and patient reported pain outcomes at POD 30 following spinal surgery. <h3>STUDY DESIGN/SETTING</h3> Patients undergoing spine surgery from 2012-2018 at a tertiary care referral facility. The prescribed opioid dose was converted to morphine milligram equivalents (MME) per day using a standard reference table. Nonsteroidal anti-inflammatory drug (NSAID) or Acetaminophen regimen was classified as either low dose or high dose non-opiate analgesics based on the median doses currently prescribed. <h3>PATIENT SAMPLE</h3> Inclusion criteria included: (1) patients who had clinical follow-up with preoperative (preop), POD 1, and POD 25-35 (referred to as POD 30) pain scores reported on the visual analog scale (VAS); (2) patients who were discharged from the hospital in good health. A total of 1,428 patients met inclusion criteria. <h3>OUTCOME MEASURES</h3> (1) Postoperative day 30 (POD30) visual analog scale (VAS) pain score; (2) 50% reduction in patient reported pain score between preop and POD 30. <h3>METHODS</h3> Patients with previous history of opioid usage or those receiving treatment for malignancy, trauma, or infection were excluded. Patient reported pain outcomes at preoperative and various postoperative days were measured using the visual analog scale. Chi-square, Kruskal-Wallis, linear, and logistic regression were used to investigate associations between covariates and postoperative pain scores. <h3>RESULTS</h3> Results of our univariate and multivariable linear regression found a patient POD 1 VAS to be associated with POD 30 VAS scores (P<0.0001). Additionally, the lowest prescribed dose of opioids [0-40 MME/day] was found to be significantly associated with worsened POD30 VAS scores (P=0.019). However, when constructing a multivariable regression model accounting for a patient's multimodal analgesic regimen, the association between lowest opioid dosage (<40MME/day) and POD30 VAS pain scores was no longer significant when patients were co-prescribed high dose, non-opiate analgesics (P=0.752). Overall, patient-reported outcome scores assess a patient's perception of improvement after an intervention, traditionally focusing on improved pain and functional ability relative to preop. To address this, we investigated the relationship between prescribed opioid doses and the likelihood that a patient experienced at least 50% pain improvement from their preoperative VAS pain score. Notably, postop opioid prescription dosages were not significant predictors of patients who reported at least 50% pain improvement. <h3>CONCLUSIONS</h3> Our study found that patients receiving the lowest dosage of opioid prescriptions (<40MME/day) along with high dose non-opiate analgesics did not report worse pain relief at 30 days postoperatively compared to those receiving higher opioid dosages along with NSAIDs. In light of the current opioid epidemic, our study highlights a need to standardize postoperative opioids to the lowest effective prescription dose. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

181. Is patient geography a risk factor for chronic opioid use after ACDF?

181. Is patient geography a risk factor for chronic opioid use after ACDF?

150. The effect of online prescription drug monitoring on opioid prescription habits after single level lumbar fusion

<h3>BACKGROUND CONTEXT</h3> The United States opioid epidemic is a well-documented crisis stemming from increased prescription of narcotics, leading to widespread misuse of both prescription and nonprescription opioid pain relievers. To combat this epidemic, online prescription drug monitoring programs (PDMPs) have been implemented at the state level to track prescriptions of controlled substances and mitigate potential misuse and addiction. <h3>PURPOSE</h3> To evaluate prescription trends of opioids over time following implementation of an online PDMP in patients who underwent single-level lumbar fusion. <h3>STUDY DESIGN/SETTING</h3> Retrospective cohort analysis. <h3>PATIENT SAMPLE</h3> Patients 18 years of age or older who underwent single-level lumbar fusion for spinal stenosis, spondylolisthesis, or disc herniation. <h3>OUTCOME MEASURES</h3> Pre- and postoperative per-patient average total opioid prescriptions, prescriptions obtained by private pay, number of prescribers, number of pharmacies, number of pills/liquid doses, refills, duration of use (days), total milligram morphine equivalents (MME) per patient, preoperative opioid naivety (defined as no documented opioid prescription within one year prior to surgery), and postoperative chronic opioid use (defined as filling ten or more prescriptions, or receiving 120 or more days of opioid prescriptions, within the first year after surgery excluding the initial 90-day postoperative period). <h3>Methods</h3> Patients who underwent single-level lumbar fusion between January 1st, 2017 and December 30, 2019 were identified. Patients were placed into one of two cohorts: (1) patients whose procedure occurred during 2017, the first calendar year following implementation of the local online PDMP, and (2) patients whose procedures occurred during 2019. Opioid use data was obtained by searching for each patient in the state government's online PDMP and recording data within the year prior to and the year following the patient's procedure. <h3>Results</h3> A total of 393 patients were included in the study. One hundred seventy-two were included in the 2017 cohort, while 221 were included in the 2019 cohort. Preoperatively, the 2019 cohort obtained significantly greater average of preoperative prescription opioids via private pay compared to 2017 (0.4 ± 1.5 vs 0.1 ± 1.6, p=0.01). Postoperatively, the 2019 cohort obtained on average a greater total number of opioid prescriptions (4.0 ± 6.1 vs 2.8 ± 4.9, p=0.046), and obtained opioid prescriptions from a greater average number of prescribers (1.8 ± 1.4 vs 1.4 ± 1.6, p=0.01) and pharmacies (1.1 ± 0.7 vs 0.8 ± 0.8, p=0.001). <h3>Conclusions</h3> Despite implementation of an online PDMP, increases were found from 2017 to 2019 in per-patient preoperative prescriptions obtained by private pay as well as average total postoperative opioid prescriptions and average number of prescribers and pharmacies. While the exact effect of different strategies aimed at decreasing the misuse and abuse of narcotic medications is unclear, use of an online PDMP is not sufficient to discourage opioid use in patients undergoing single-level lumbar fusion. Future studies should determine the effect of other strategies, such as pain management modalities that do not involve opioid prescriptions, on discouraging opioid abuse. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Opioid analgesic use after ambulatory surgery: a descriptive prospective cohort study of factors associated with quantities prescribed and consumed

ObjectivesTo prospectively characterise: (1) postoperative opioid analgesic prescribing practices; (2) experience of patients undergoing elective ambulatory surgeries and (3) impact of patient risk for medication misuse on postoperative pain management.DesignLongitudinal...

Video-Based, Patient-Focused Opioid Education in the Perioperative Period Increases Self-Perceived Opioid-Related Knowledge: A Pilot Study.

ObjectiveThe aim of this study was to evaluate whether a video-based, patient-focused opioid education tool delivered in the perioperative period would decrease acute and chronic post-operative opioid prescription dispensations and increase self-rated knowledge about opioids.MethodsWe enrolled 110 patients with no reported opioid use in the previous 30 days, undergoing ambulatory surgery for breast, orthopedic, gynecologic, or other outpatient procedures for which opioids would be prescribed. Patients were randomized to receive either post-operative opioid education by the surgical team (control arm) or pre-operative education via a novel 5-minute video plus post-operative education by the surgical team (intervention arm). All patients received follow-up phone calls on post-operative day (POD) 7 to assess self-rated knowledge of opioids on a scale of 1 to 10, 10 being most informed, and self-reported opioid use (primary outcome). Arkansas Prescription Drug Monitoring Program (AR PDMP) data were obtained to assess opioid dispensations at POD 90–150 days.ResultsSeventy-seven percent of participants completed POD7 survey. Participants in the intervention arm rated their knowledge of opioids after surgery significantly higher than those in the control arm (p=0.013). Data from the AR PDMP reveal trends (non-significant) that show increased use of opioids in the control group when compared to the video intervention group at POD 30 (88.7% vs 76%) and POD 90–150 (22.6% vs 10%).ConclusionVideo-based, patient-focused opioid education can be effectively implemented in a large university hospital during the perioperative period and is effective for increasing a patient’s perception of opioid-related knowledge. A fully powered, randomized control trial is needed to further explore observed trends and determine if this novel tool can decrease chronic post-operative opioid dispensations.

Assessment of post-operative opioid prescribing practices in a community hospital ambulatory surgical center.

To evaluate the prescribing practices and opioid consumption in an ambulatory setting to inform the development of evidence-based guidelines. A prospective study of adults undergoing outpatient open and laparoscopic surgeries over 3 months. One week after discharge, a telephonic interview quantified the number of opioids prescribed and consumed, degree of pain control and satisfaction, and whether additional pain medication was requested. Community hospital ambulatory surgery center in Westchester County, New York. This study included 304 adults undergoing a variety of procedures by surgeons from multiple specialties. Quantify surgeons' postoperative opioid prescribing compared with patient opioid consumption. Eighty-one percent (N = 245) responded to the survey, of which 64 percent were prescribed opioids. Males and females were equally represented with the mean age of 59.4 years. Of those prescribed opioids, 92 percent filled the prescription. The most commonly prescribed opioids reported by the patients that filled their prescription (N = 145) were oxycodone (36.5 percent), oxycodone/acetaminophen (28.9 percent), and tramadol (22.7 percent). The mean number of opioid pills prescribed was 20 and the mean consumption was 6.7 pills, resulting in an average of 13 retained pills. Only 3.8 percent of the patients prescribed opioids at discharge called their provider for additional analgesia. Despite the low opioid consumption patients reported high satisfaction (4.5 on scale of 0-5) with pain control. Only 10.4 percent reported that the surgeon recommended an over the counter (OTC) analgesic option. There was variability in the amount of opioids prescribed within each surgical category. One week after outpatient surgery, patients consumed one-third of physician-prescribed opioids, yet they reported high pain management satisfaction. Our study will inform the development of a patient-centered interdisciplinary perioperative education program to more effectively tailor multimodal pain management in ambulatory surgical patients and collaterally reduce the number of retained opioids.

Opioid Prescribing for Proximal Row Carpectomy versus Four-Corner Arthrodesis.

Background Proximal row carpectomy (PRC) and four-corner arthrodesis (4-CA) represent motion-sparing procedures for addressing degenerative wrist pathologies. While both procedures demonstrate comparable functional outcomes, postoperative pain presents a surgical challenge that often necessitates the use of opioids. Objectives The aim of this study was to (1) compare opioid prescribing patterns surrounding PRC and 4-CA, (2) identify risk factors predisposing patients to increased perioperative and prolonged postoperative opioids, and (3) examine the association between opioids and perioperative health care utilization. Patients and Methods PearlDiver Patients Records Database was used to retrospectively identify patients undergoing primary PRC and 4-CA between 2010 and 2018. Patient demographics, comorbidities, prescription drug usage, and perioperative health care utilization were evaluated. Perioperative opioid prescriptions and post-operative opioid prescriptions were recorded. Logistic regression analysis evaluated the association of patient risk factors. Results There was no significant difference in perioperative (PRC [odds ratio {OR}: 0.84, p = 0.788]; 4-CA [OR: 0.75, p = 0.658]) or prolonged postoperative opioid prescriptions (PRC [OR: 0.95, p = 0.927]; 4-CA [OR: 0.99, p = 0.990]) between PRC and 4-CA. Chronic back pain and use of benzodiazepines or anticonvulsants were associated with increased risks of prolonged postoperative opioids. Prolonged postoperative opioids presented increased risks of emergency department visits (OR: 2.09, p = 0.019) and hospital readmissions (OR: 10.2, p = 0.003). Conclusion No significant differences exist in the prescription of opioids for PRC versus 4-CA. Both procedures have high amounts of prolonged postoperative opioid use, which is associated with increased risks of emergency department visits and hospital readmissions. Level of Evidence This is a level III, retrospective comparative study.

Postoperative pediatric urology opioid prescriptions at a tertiary academic medical center

Opioid abuse is a public health crisis, and often this starts postoperatively. Limited data are available on pediatric urology practitioners. We examined the likelihood of postoperative opioid prescriptions in our practice. To determine rates of post-operative opioid prescriptions following urologic surgery in a tertiary academic center, and to identify what factors are related to opioid prescriptions. We retrospectively reviewed opioid prescriptions for children who underwent a procedure in the operating room between 1/1/17 and 12/31/19. We collected data on gender, age, surgeon, procedure, length of stay, ethnicity, race, and whether opioids had been used pre-operatively. We grouped procedures into five categories: minor penile surgery, cystoscopic procedures, scrotal surgery, hypospadias repair/penoplasty, and pyeloplasty/ureteral reimplant. Multivariable logistic regression was used to determine odds ratios (OR) of opioid prescriptions. 1102 procedures had data available. 14.2% (n=156) received opioid prescriptions. Using minor penile surgery as a baseline, scrotal surgery increased the odds of an opioid by 1.42; hypospadias, pyeloplasty, and other procedures reduced the odds by 0.53, 0.55, and 0.54, respectively (no patient received opioids for endoscopic procedures). Ambulatory procedures had a lower rate of opioids (0.40), and age was a major factor, with the odds of a prescription increasing by a factor of 1.45 per year of age. Since January of 2017, the opioid prescription rate has decreased from 18% in 2017 to 7.7% in 2019. We found a relatively low rate of opioid prescribing in our pediatric patients, mostly in older children undergoing penile and scrotal procedures. Our rate was comparable to several other institutions that have examined their prescription rates in surgical patients. Heightened awareness has resulted in decreased opioid usage over time (to 6.9%). Limitations included the retrospective nature of our study, which did not allow us to assess whether pain control was adequate or if the opioids prescribed were used by patients. Opioids are rarely needed in pediatric patients. 85.8% of post-operative pediatric urology patients at our institution were not provided with prescription opioids. Factors associated with a higher likelihood of receiving a prescription were increasing age and scrotal surgery.

Opioids Are Infrequently Required following Ambulatory Otologic Surgery.

To determine the frequency with which postoperative opioid prescriptions are required after ambulatory otologic surgery. Retrospective chart review. Tertiary otology-neurotology practice. Patients (n = 447) given over-the-counter acetaminophen and ibuprofen following ambulatory otologic surgery between July 1, 2018 and June 30, 2020. Opioid prescription upon request. Patient, disease, and surgical variables such as age, sex, past medical history, chronic pain condition, surgical procedure, primary versus (vs.) revision surgery, and endoscopic vs. microscopic approach were examined for relationship to ad hoc opioid prescription rate. Of 370 adult patients (mean age 49.0 yrs, range 18.0-88.5 yrs), 75 (20.3%) were prescribed opioids for postoperative pain, most commonly oxycodone-acetaminophen 5/325 mg. Of 77 pediatric patients (mean age 8.8 yrs, range 0.7-17.9 yrs), 5 (6.5%) were prescribed postoperative opioid analgesia. In the adult population, chronic pain condition, pain medication use at baseline, canal wall up mastoidectomy, tympanoplasty, tympanomeatal flap, bone removal of the mastoid, postauricular incision, and intraoperative microscopy were independent predictors of opioid pain prescription. When controlling for all significant variables, only chronic pain condition remained significant (odds ratio = 3.94; p = 0.0007). In the pediatric population, atresiaplasty, meatoplasty, and conchal cartilage removal were independently associated with opioid prescription, but none remained significant when analyzed in a multivariate linear model. Pain following ambulatory otologic surgery may be adequately managed with over-the-counter pain medications in the majority of cases. Opioids may be necessary in adults with preexisting pain conditions.

Optimization of postoperative opioid prescriptions in gynecologic oncology: Striking a balance between opioid reduction and pain control

ObjectiveTo implement a quality-improvement initiative to assess the impact various patient and procedural factors have on postoperative opioid use. To develop a tailored opioid prescribing algorithm for gynecologic oncology patients. MethodsA retrospective cohort study was performed of patients who underwent a laparoscopy or laparotomy procedure for a suspected or known gynecologic malignancy between 3/2019–9/2020. Patients were assessed preoperatively for the presence of suspected risk factors for opioid misuse (depression, anxiety, chronic pain, current opioid use, or substance abuse). Patients completed a 30-day postoperative questionnaire assessing for total opioid pill use and refills requests. Multivariate models were developed to estimate the independent effect of sociodemographic characteristics, risk factors for opioid misuse and procedural factors on patient reported postoperative opioid use. ResultsA total of 390 patients were analyzed. Thirty-nine percent (N = 151/390) of patients reported not using opioids after discharge and 5% (N = 20/390) received an opioid refill.For both minimally invasive procedures and laparotomy procedures, body mass index, comorbidities, intraoperative or postoperative complications and final diagnosis of malignancy were not associated with the amount of opioid consumption. However, younger age and history of risk factors for opioid misuse significantly impacted postoperative opioid use. In multivariate analysis, age (p = 0.038) and risk factors (p < 0.001) remained significant after controlling for other factors. ConclusionsTwo out of every five patients did not use opioids after surgery. Younger patients and those with risk factors for opioid misuse need a tailored approach to prescribing opioids to balance the need for adequate pain control with the risk of misuse.

Retrospective study of the effect of opioid prescribing guidelines on prescribing practices in pediatric orthopedic sports medicine patients having knee surgery: A single institution's experience.

Guidelines for opioid prescription post-operatively exist; however, the majority of these are for adults. Nevertheless, opioid risks are present for pediatric patients also. This study investigates the effect of a single institution's guidelines on post-operative opioid prescribing for pediatric orthopedic patients undergoing knee surgery. We hypothesized that a standardized set of prescribing guidelines would result in a decrease in opioids prescribed at discharge home after these surgeries. Retrospective observational. Urban, tertiary care, academic orthopedic hospital. Pediatric, sports knee surgery, 23-month period. Guidelines were implemented institutionally for post-operative opioid prescribing practices. We reviewed all post-operative opioid prescriptions for pediatric patients undergoing sports knee surgery with two pediatric sports surgeons for the 11 months prior to the guidelines and 12 months afterwards, totaling 316 surgeries. Oral morphine equivalents (OMEs) prescribed on discharge from the hospital before and after implementation of guidelines. There was a significant reduction in OMEs from 229 OMEs to 175 OMEs before and after opioid prescribing guidelines (p < 0.001). This is a decrease in approximately seven 5 mg oxycodone tablets per patient. This study demonstrates that at our institution, with a pediatric patient population having sports knee surgery, prescribing guidelines reduced the number of opioids prescribed at discharge.

DECREASE PRESCRIBING OF POSTOPERATIVE OPIOIDS IN PEDIATRIC ACL RECONSTRUCTION- TREATMENT TRENDS AT A SINGLE CENTER

Background:Pain control following ACL Reconstruction (ACLR) presents a unique challenge due to age and early rehabilitation needs. Significant efforts have been made to reduce unnecessary opioid prescribing in this vulnerable population, but few have sought to define current practices.Purpose:The purpose of this study is to describe trends in postoperative pain management and assess factors that may mitigate overutilization of opioid medications.Methods:This is a retrospective review of a series of pediatric patients (<18yo) undergoing primary ACLR within an urban academic hospital system over a 5-year period (2014-2018). The period included the gradual introduction of preoperative consenting for opioid use in minors as mandated by state law in 2016. Patient demographics, surgical details, presence of opioid consent, prescribed postoperative medications, prescriber, and indicators of inadequate pain control were collected. Trends in medication prescribing were assessed. Univariate and multivariate analyses were performed to identify factors associated with reduced postoperative opioid prescribing.Results:This study included 687 patients with a mean age of 15.1±1.9 years. The majority underwent ACL reconstruction using hamstring autograft (92.0%) at our main hospital (54.9%). Postoperatively, discharge medication prescribing was performed most frequently (38.1%) by advanced practitioners (NP/PA). While there was no change in the proportion of patients prescribed opioids (>95% of patients) over the 5 year period, the mean number of doses dispensed decreased annually (Fig. 1). This was accompanied by an increase in the annual percentage of patients prescribed oral NSAIDs and acetaminophen during that period. Preoperative opioid consent was obtained in 31.9% of the cohort and these patients received significantly fewer doses of prescribed opioids (25.0 vs. 34.6 doses, p<0.001), while still having a lower rate of uncontrolled pain prompting early unplanned contact via telephone, ED or clinic. Preoperative consenting (IRR 0.764, CI 0.634-0.920, p=0.005) and satellite surgical location (IRR 0.712, CI 0.517-0.979, p=0.037) were identified as significant predictors of decreased number of postoperative opioid doses prescribed following multivariate regression analysis (Table 2).Conclusion:Total doses of postoperative opioids prescribed for pain management in pediatric ACLR have declined in recent years, which appears related to preoperative counseling through mandated opioid consenting and paralleled by greater utilization of non-opioid medications. Continued efforts should be made to identify measures to limit overreliance on these medications and to mitigate issues related to misuse, overdose and addiction.Figure 1.ACL Reconstruction Postoperative Pain Medication Prescribing TrendsAnnual proportion of patients prescribed ibuprofen, acetaminophen and opioid medication postoperatively and the annual mean number of opioid doses prescribed.Univariate and multivariate negative binomial regression analysis of factors associated with prescription of a greater number of postoperative doses of opioid medication. CI = Confidence Interval.