Guidelines Reduce Opioid Prescriptions By 40%

Research shows opioid use on the last day in the hospital is the strongest predictor for determining how many opioid pills surgical patients would use once they got home.

Vigilant prescribing guidelines for surgeons could reduce by as much as 40% the number of opioid pills prescribed after operations, and still meet patients’ pain management needs, according to research published in the Journal of the American College of Surgeons.

“We specifically looked at the number of opioid pills that surgical inpatients took the day before discharge from the hospital, and we found that this number was the strongest predictor of how many opioid pills the patients would use after discharge,” said study lead author Richard J. Barth Jr., MD, a general surgeon at Dartmouth Hitchcock Medical Center in Lebanon, NH.

The researchers recommend following schedule for post-discharge prescription based on the number of opioid pills taken the day before discharge: No pills for patients who took no opioids the day before they left the hospital; 15 pills for those who took one-to-three pills the day before; and 30 pills for those who took four-or-more pills on their last day in the hospital.

Using phone calls and questionnaires, the study tracked 333 hospital inpatients discharged to home after six types of general surgery: bariatric procedures; operations on the stomach, liver, and pancreas; ventral hernia repair; and colon operations.

“This guideline was true for multiple different operations,” Barth said. “It didn’t matter whether someone had a colon operation, liver procedure or hernia repair; no matter what type of general surgery operation they had, this association held throughout all procedures studied. So the beauty of this finding is that one guideline would apply for multiple different surgical procedures.”

While 85% of patients were prescribed opioids after they went home, only 38% of the pills were taken. Age also influenced patient opioid use. Patients younger than age 60 averaged about 13 pills after discharge while those 60 and older averaged four pills.

The study also looked at why a small fraction of patients took more opioids than the new guidelines called for. “Over half of them were taking opioids for non-pain-related reasons, such as to sleep better, or because they felt they should take all the pills the physician prescribed and other various and sundry reasons,” Barth said.