Many Opioid Prescriptions After Surgery Are Unnecessary, Study Finds

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Investigators analyzed 2019 data from a Michigan-wide surgical care registry and then asked patients about their experience after their recovery. The results, published in Annals of Surgery, have shown similar results and experiences with and without opioids.

Specifically, 86% of patients received a prescription for an opioid after suffering a hernia, gallbladder, appendix, bowel, thyroid, or gynecologic operations. However, when the researchers compared the experiences of these patients and survey responses with data from the 14% of patients who received prescriptions for non-opioid pain relievers, they found very little difference.

An equal percentage (12%) of each group had a major adverse event within 30 days of their initial surgery. There was no difference in complications, emergency department visits, or reoperations between groups, and patients who did not receive an opioid prescription were slightly more likely to be readmitted to the hospital. hospital. Investigators noted, however, that these readmissions were rarely due to pain-related issues, according to the press release. There was also no difference in the percentage who sought emergency pain care.

The survey was carried out between 1 and 3 months after their operation and asked patients about their pain levels in the first 7 days after discharge from hospital, their satisfaction with their care, their quality. of life and their level of regret at having been operated. Almost 60% of patients responded to the survey.

Among the two groups, 82% of respondents said they were very satisfied with their care. In addition, 93% of both groups said they did not regret their surgery.

Patients who received prescriptions without opioids were actually more likely to report having no pain in the first week after surgery than those who received opioids (12% and 7%, respectively). Non-opioid patients were also more likely to say they had the best possible quality of life after surgery (66% and 63%, respectively).

“Opioids have been part of the routine of post-surgical pain care for decades, but the risk that they can lead to persistent use has been clearly documented,” said lead author Ryan Howard, MD, resident. in surgery at Michigan Medicine, in the press. Release. “Maybe it’s time to make it the exception, not the rule.”

Investigators noted that 16% of patients in the study were taking opioids continuously before their operations. It’s important to note that long-term opioid use is known to increase the risk of surgery, according to the study.

“This study clearly shows no difference in pain, major adverse events, or patient-centered outcomes when opioids are not prescribed,” said lead author Mark Bicket, MD, PhD, Michigan co-director Opioid Prescribing Engagement Network, in press release. “The growing body of evidence on the risk of opioid drugs to the patient and to others who might abuse the patient’s remaining prescription pills must be considered along with the evidence for their relative effectiveness for pain control. “

A second new study used data from national insurance claims to document the new persistent opioid use and costs of care for surgical patients who had not taken opioids prior to their operations. These results, also from Michigan Medicine, were published in the Journal of Managed Care and Specialty Pharmacy.

Investigators found that between 4% and 7% of all patients who had surgery requiring a hospital stay continued to fill opioid prescriptions months after their pain should have subsided. The authors defined this trend as persistent opioid use. The same was true for between 1.5% and 6.4% of patients operated on as an outpatient. None of the patients in this study had filled prescriptions for opioids before their surgery.

Patients with persistent opioid use after surgery received more hospital and emergency care within a year of their operation compared to patients who did not fill an opioid prescription immediately after their operation . Although some of the patients who did not fill an opioid prescription received opioids for other reasons later in the year of follow-up, researchers said those who started taking opioids after surgery received 5 times more opioid prescriptions and much higher overall health care costs.

REFERENCE

Gavin K. Many operated patients receive prescriptions for opioids, but many do not need them, study finds. Michigan Medical Health Laboratory. June 11, 2021. Accessed June 22, 2021. https://labblog.uofmhealth.org/rounds/many-surgery-patients-get-opioid-prescriptions-but-many-dont-need-to-study-suggests


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