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

Abstract

Objectives To 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. Design Longitudinal survey of patients 7\u2009days before and 7–14 days after surgery. Setting Academic urban safety-net hospital. Participants 181 participants recruited, 18 surgeons, follow-up data from 149 participants (82% retention); 54% women; mean age: 49 years. Interventions None. Primary and secondary outcome measures Total morphine equivalent dose (MED) prescribed and consumed, percentage of unused opioids. Results Surgeons postoperatively prescribed a mean of 242 total MED per patient, equivalent to 32 oxycodone (5\u2009mg) pills. Participants used a mean of 116 MEDs (48%), equivalent to 18 oxycodone (5\u2009mg) pills (~145\u2009mg of oxycodone remaining per patient). A 10-year increase in patient age was associated with 12 (95% CI (−2.05 to –0.35)) total MED fewer prescribed opioids. Each one-point increase in the preoperative Graded Chronic Pain Scale was associated with an 18 (6.84 to 29.60) total MED increase in opioid consumption, and 5% (−0.09% to –0.005%) fewer unused opioids. Prior opioid prescription was associated with a 55 (5.38 to –104.82) total MED increase in opioid consumption, and 19% (−0.35% to –0.02%) fewer unused opioids. High-risk drug use was associated with 9% (−0.19% to 0.002%) fewer unused opioids. Pain severity in previous 3\u2009months, high-risk alcohol, use and prior opioid prescription were not associated with postoperative prescribing practices. Conclusions Participants with a preoperative history of chronic pain, prior opioid prescription, and high-risk drug use were more likely to consume higher amounts of opioid medications postoperatively. Additionally, surgeons did not incorporate key patient-level factors (eg, substance use, preoperative pain) into opioid prescribing practices. Opportunities to improve postoperative opioid prescribing include system changes among surgical specialties, and patient education and monitoring.