Post-Discharge Opioid Prescribing Patterns and Risk Factors in Patients Undergoing Elective Colon and Rectal Surgery Without Complications
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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.
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.
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.
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.
KeywordsNSQIP Opioid Risk Tool Colorectal surgery
Chronic ulcerative colitis
Enhanced recovery pathway
Hand-assisted laparoscopic surgery
- IPAA TPC
Ileal pouch-anal anastomosis total proctocolectomy
Morphine milligram equivalents
American College of Surgeons National Surgical Quality Improvement Program
Opioid Risk Tool
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.
- 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.
- 12.Hill, M.V., et al., Wide Variation and Excessive Dosage of Opioid Prescriptions for Common General Surgical Procedures. Ann Surg, 2016.Google Scholar