Advertisement

Post-Discharge Opioid Prescribing Patterns and Risk Factors in Patients Undergoing Elective Colon and Rectal Surgery Without Complications

  • Jeffrey S. Scow
  • Nicholas M. Tomhave
  • Jenna K. Lovely
  • Grant M. Spears
  • Marianne Huebner
  • David W. Larson
Original Article
  • 21 Downloads

Abstract

Background

Few studies have examined opioid usage in the post-discharge period. The primary aim of this study was to evaluate the need for post-discharge opioids in a unique set of patients: those undergoing colorectal operations and experiencing no surgical complications. The secondary aim was to examine the accuracy of the Opioid Risk Tool (ORT) to predict the need for additional opioid prescriptions. Our hypotheses were that few patients would require post-discharge opioids and that the ORT would predict patients requiring post-discharge opioids.

Methods

All patients undergoing elective colorectal surgery between January 2012 and December 2014 that did not experience NSQIP complications within 30 days or receive an opioid prescription in the 2 weeks prior to operation were reviewed. ORT score was calculated for all patients. Patients requiring post-discharge opioids within 1 year were compared to those not receiving additional opioids after discharge.

Results

There were 367 patients that met inclusion criteria and 56 (15%) received post-discharge opioids. Opioid use in the year prior to surgery was the only significant risk factor to receive post-discharge opioids. Opioids were prescribed for three distinct reasons by three groups of prescribers. The ORT did not accurately predict need for post-discharge opioids.

Conclusions

Even among patients without complications, 15% received post-discharge opioid prescriptions. Previous opioid use within the year prior to surgery was a major risk factor for additional prescriptions. The timing and prescriber’s specialty are impacted by the indication for post-discharge opioids. The ORT did not predict which patients would receive post-discharge opioids.

Keywords

NSQIP Opioid Risk Tool Colorectal surgery 

Abbreviations

CUC

Chronic ulcerative colitis

ERP

Enhanced recovery pathway

HALS

Hand-assisted laparoscopic surgery

IPAA TPC

Ileal pouch-anal anastomosis total proctocolectomy

IQR

Interquartile range

MMEs

Morphine milligram equivalents

NSQIP

American College of Surgeons National Surgical Quality Improvement Program

ORT

Opioid Risk Tool

RX

Prescription

Notes

Author Contributions

Conception and design of the study: Tomhave, Lovely, Huebner, Larson.

Acquisition of data: Tomhave, Lovely, Larson.

Analysis and interpretation of data: All authors.

Drafting of manuscript: Scow, Tomhave, Lovely, Larson.

Critical revision for important intellectual content: Scow, Lovely, Huebner, Larson.

Final approval: All authors.

Compliance with Ethical Standards

This retrospective study was approved by the Mayo Clinic Institutional Review Board and took place at a high volume, referral center in the Midwestern United States.

References

  1. 1.
    HHS Acting Secretary Declares Public Health Emergency to Address National Opioid Crisis [press release]. Washington DC. Department of Health and Human Services Press Office; October 26, 2017. https://www.hhs.gov/about/news/2017/10/26/hhs-acting-secretary-declares-public-health-emergency-address-national-opioid-crisis.html . Accessed December 10, 2017.
  2. 2.
    Rudd, R.A., et al., Increases in Drug and Opioid-Involved Overdose Deaths - United States, 2010-2015. MMWR Morb Mortal Wkly Rep, 2016. 65(5051): p. 1445–1452.CrossRefGoogle Scholar
  3. 3.
    Carroll, I., et al., A pilot cohort study of the determinants of longitudinal opioid use after surgery. Anesth Analg, 2012. 115(3): p. 694–702.PubMedGoogle Scholar
  4. 4.
    Clarke, H., et al., Rates and risk factors for prolonged opioid use after major surgery: population based cohort study. BMJ, 2014. 348: p. g1251.CrossRefGoogle Scholar
  5. 5.
    Sun, E.C., et al., Incidence of and Risk Factors for Chronic Opioid Use Among Opioid-Naive Patients in the Postoperative Period. JAMA Intern Med, 2016. 176(9): p. 1286–93.CrossRefGoogle Scholar
  6. 6.
    Thiels, C.A., et al., Wide Variation and Overprescription of Opioids After Elective Surgery. Ann Surg, 2017. 266(4): p. 564–573.CrossRefGoogle Scholar
  7. 7.
    Alam, A., et al., Long-term analgesic use after low-risk surgery: a retrospective cohort study. Arch Intern Med, 2012. 172(5): p. 425–30.CrossRefGoogle Scholar
  8. 8.
    Miller, N.S., Failure of enforcement controlled substance laws in health policy for prescribing opiate medications: a painful assessment of morbidity and mortality. Am J Ther, 2006. 13(6): p. 527–33.CrossRefGoogle Scholar
  9. 9.
    Bohnert, A.S., et al., Association between opioid prescribing patterns and opioid overdose-related deaths. JAMA, 2011. 305(13): p. 1315–21.CrossRefGoogle Scholar
  10. 10.
    Bartels, K., et al., Opioid Use and Storage Patterns by Patients after Hospital Discharge following Surgery. PLoS One, 2016. 11(1): p. e0147972.CrossRefGoogle Scholar
  11. 11.
    Bates, C., et al., Overprescription of postoperative narcotics: a look at postoperative pain medication delivery, consumption and disposal in urological practice. J Urol, 2011. 185(2): p. 551–5.CrossRefGoogle Scholar
  12. 12.
    Hill, M.V., et al., Wide Variation and Excessive Dosage of Opioid Prescriptions for Common General Surgical Procedures. Ann Surg, 2016.Google Scholar
  13. 13.
    Kim, N., et al., A Prospective Evaluation of Opioid Utilization After Upper-Extremity Surgical Procedures: Identifying Consumption Patterns and Determining Prescribing Guidelines. J Bone Joint Surg Am, 2016. 98(20): p. e89.CrossRefGoogle Scholar
  14. 14.
    Kalkman, C.J., et al., Preoperative prediction of severe postoperative pain. Pain, 2003. 105(3): p. 415–23.CrossRefGoogle Scholar
  15. 15.
    Carroll, I.R., et al., Pain Duration and Resolution following Surgery: An Inception Cohort Study. Pain Med, 2015. 16(12): p. 2386–96.CrossRefGoogle Scholar
  16. 16.
    Adams, L.L., et al., Development of a self-report screening instrument for assessing potential opioid medication misuse in chronic pain patients. J Pain Symptom Manage, 2004. 27(5): p. 440–59.CrossRefGoogle Scholar
  17. 17.
    Belgrade, M.J., C.D. Schamber, and B.R. Lindgren, The DIRE score: predicting outcomes of opioid prescribing for chronic pain. J Pain, 2006. 7(9): p. 671–81.CrossRefGoogle Scholar
  18. 18.
    Butler, S.F., et al., Validation of the revised Screener and Opioid Assessment for Patients with Pain (SOAPP-R). J Pain, 2008. 9(4): p. 360–72.CrossRefGoogle Scholar
  19. 19.
    Dowling, L.S., et al., An evaluation of the predictive validity of the Pain Medication Questionnaire with a heterogeneous group of patients with chronic pain. J Opioid Manag, 2007. 3(5): p. 257–66.CrossRefGoogle Scholar
  20. 20.
    Jones, T., S. Lookatch, and T. Moore, Validation of a new risk assessment tool: the Brief Risk Questionnaire. J Opioid Manag, 2015. 11(2): p. 171–83.CrossRefGoogle Scholar
  21. 21.
    Webster, L.R. and R.M. Webster, Predicting aberrant behaviors in opioid-treated patients: preliminary validation of the Opioid Risk Tool. Pain Med, 2005. 6(6): p. 432–42.CrossRefGoogle Scholar
  22. 22.
    Butler, S.F., et al., Development and Validation of the Current Opioid Misuse Measure. Pain, 2007. 130(1–2): p. 144–156.CrossRefGoogle Scholar
  23. 23.
    Larson, D.W., et al., Outcomes after implementation of a multimodal standard care pathway for laparoscopic colorectal surgery. Br J Surg, 2014. 101(8): p. 1023–30.CrossRefGoogle Scholar
  24. 24.
    Lovely, J.K., et al., Case-matched series of enhanced versus standard recovery pathway in minimally invasive colorectal surgery. Br J Surg, 2012. 99(1): p. 120–6.CrossRefGoogle Scholar
  25. 25.
    Larson, D.W., et al., A fast-track recovery protocol improves outcomes in elective laparoscopic colectomy for diverticulitis. Journal of the American College of Surgeons, 2010. 211(4): p. 485–9.CrossRefGoogle Scholar
  26. 26.
    Ingraham, A.M., et al., Quality improvement in surgery: the American College of Surgeons National Surgical Quality Improvement Program approach. Adv Surg, 2010. 44: p. 251–67.CrossRefGoogle Scholar
  27. 27.
    Dowell, D., T.M. Haegerich, and R. Chou, CDC Guideline for Prescribing Opioids for Chronic Pain--United States, 2016. JAMA, 2016. 315(15): p. 1624–45.CrossRefGoogle Scholar
  28. 28.
    Gilson, A.M., et al., Using a morphine equivalence metric to quantify opioid consumption: examining the capacity to provide effective treatment of debilitating pain at the global, regional, and country levels. J Pain Symptom Manage, 2013. 45(4): p. 681–700.CrossRefGoogle Scholar
  29. 29.
    Jiang, X., et al., Chronic Opioid Usage in Surgical Patients in a Large Academic Center. Ann Surg, 2017. 265(4): p. 722–727.CrossRefGoogle Scholar
  30. 30.
    Moore, T.M., et al., A comparison of common screening methods for predicting aberrant drug-related behavior among patients receiving opioids for chronic pain management. Pain Med, 2009. 10(8): p. 1426–33.CrossRefGoogle Scholar
  31. 31.
    Jones, T., et al., A comparison of various risk screening methods in predicting discharge from opioid treatment. Clin J Pain, 2012. 28(2): p. 93–100.CrossRefGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2018

Authors and Affiliations

  • Jeffrey S. Scow
    • 1
  • Nicholas M. Tomhave
    • 2
  • Jenna K. Lovely
    • 3
  • Grant M. Spears
    • 4
  • Marianne Huebner
    • 5
  • David W. Larson
    • 1
  1. 1.Colon and Rectal SurgeryMayo ClinicRochesterUSA
  2. 2.St. Olaf CollegeNorthfieldUSA
  3. 3.Mayo Clinic PharmacyRochesterUSA
  4. 4.Department of Health Sciences ResearchMayo ClinicRochesterUSA
  5. 5.Department of Statistics and ProbabilityMichigan State UniversityEast LansingUSA

Personalised recommendations