Opioid Use After Ambulatory Surgery: Mismatch Between Prescribed and Used
2
Opioid Use After Ambulatory Surgery: Mismatch Between Prescribed and Used Christopher Shanahan MD MPH, 1 Inga Holmdahl BA, 1 Olivia Gamble BA, 1 Julia Keosaian MPH, 1 Marc LaRochelle MD MPH, 1 Ziming Xuan ScD, 2 Jane Liebschutz MD MPH 1 1 Department of General Internal Medicine, Boston University School of Medicine and Boston Medical Center; 2 Department of Community Health Sciences, Boston University School of Public Health ABSTRACT • Overprescribing of opioids may contribute to diversion and addiction • Evidence shows that patients undergoing elective day-surgery may receive more opioids than necessary for post-operative pain management. 2,3,4 • We characterized surgeons’ post-operative opioid analgesia prescribing practices & patient experiences through a prospective study of patients undergoing elective ambulatory surgery. METHODS Study Design : • Prospective observational study • 18 different surgeons at BMC referred their patients for the study Recruitment : • Participants screened & enrolled in-person at pre-operative appointments or via phone Inclusion Criteria: • ≥18 years • Undergoing elective ambulatory surgery (Orthopedic, otolaryngology, general, podiatry, maxillofacial, gynecology, and urology) Data Collection : • Patients surveyed in person or via phone week prior to & 7-10 days after planned surgery • Electronic Health Record used to confirm surgery date & type Demographics • 181 enrolled; complete follow-up data obtained from 149 participants (83% retention) • 53% female; mean age: 49 years RESULTS Figure 1 : Participant Flow Diagram
-
Upload
boston-university-school-of-medicine -
Category
Health & Medicine
-
view
71 -
download
0
Transcript of Opioid Use After Ambulatory Surgery: Mismatch Between Prescribed and Used
Opioid Use After Ambulatory Surgery: Mismatch Between Prescribed and UsedChristopher Shanahan MD MPH, 1 Inga Holmdahl BA, 1 Olivia Gamble BA, 1 Julia Keosaian MPH, 1 Marc
LaRochelle MD MPH, 1 Ziming Xuan ScD, 2 Jane Liebschutz MD MPH1
1Department of General Internal Medicine, Boston University School of Medicine and Boston Medical Center;2Department of Community Health Sciences, Boston University School of Public Health
ABSTRACT• Overprescribing of opioids may contribute to diversion and addiction• Evidence shows that patients undergoing elective day-surgery may receive more opioids than
necessary for post-operative pain management. 2,3,4
• We characterized surgeons’ post-operative opioid analgesia prescribing practices & patient experiences through a prospective study of patients undergoing elective ambulatory surgery.
METHODS
Study Design: • Prospective observational study • 18 different surgeons at BMC referred their patients for the study
Recruitment:• Participants screened & enrolled in-person at pre-operative appointments or via phone
Inclusion Criteria: • ≥18 years • Undergoing elective ambulatory surgery (Orthopedic, otolaryngology, general, podiatry,
maxillofacial, gynecology, and urology) Data Collection:• Patients surveyed in person or via phone week prior to & 7-10 days after planned surgery• Electronic Health Record used to confirm surgery date & type as well as opioid prescription
information
Demographics• 181 enrolled; complete follow-up data obtained from 149
participants (83% retention) • 53% female; mean age: 49 years
RESULTS
Figure 1: Participant Flow Diagram
RESULTS (CONTINUED)
Post-operative usage, refills, and storage:• Participants reported taking 42% of the pills prescribed over the 10-day post-
operative period (average 15 pills each)• 71% (94) of participants reported having leftover pills• 14% (18) of participants reported taking pills more often than prescribed • 10% (13) of participants reported seeking an early refill.
CONCLUSIONS
REFERENCES
• Most participants reported using substantially less post-operative opioid pain medication than prescribed.
• Over half of participants reported plans to retain unused medications after pain resolution.
• To reduce unnecessary opioid prescribing and potential availability for diversion and misuse, improved prescribing practices and disposal options are needed.
• Future studies may include an academic detailing component to review physician prescribing practices, provide individualized feedback support to help improve practices, pre-operative pain management patient counseling and provide patient support in initiating safe opioid use and disposal.
1. Bates C, et.al. Overprescription of Postoperative Narcotics: A Look at Postoperative Pain Medication Delivery, Consumption and Disposal in Urological Practice. J. Urology. 2011;185(2):551-5. 2. Rodgers J, et.al. Opioid Consumption Following Outpatient Upper Extremity Surgery. J. Hand Surgery. 2012;37(4):645-50.3. Mutlu I, et.al. Narcotic Prescribing Habits and Other Methods of Pain Control by Oral and Maxillofacial Surgeons After Impacted Third Molar Removal. J. Oral and Maxillofacial Surgery. 2013;71(9):1500-3.
33%
33%
15%
6%5%
8%
Safe disposal (police, flushing)Keep themKeep taking themThrow awayDid not know plansOther
Figure 3: Plan for Leftover Medication at Follow-Up
Opioid Prescription• 95% of participants prescribed opioid medications for post-operative analgesia • Surgeons prescribed an average of 33 pills per participant
Figure 2: Pills Taken In Post-Operative Period (n=133)
0 1-7 8-32 33-670%5%
10%15%20%25%30%35%40%45%50%
13%
29%
46%
12%
Tablets
% o
f Par
ticip
ants
Ta
king
Opi
oids
Opioid Use After Ambulatory Surgery: Mismatch Between Prescribed and UsedChristopher Shanahan MD MPH, 1 Inga Holmdahl BA, 1 Olivia Gamble BA, 1 Julia Keosaian MPH, 1 Marc
LaRochelle MD MPH, 1 Ziming Xuan ScD, 2 Jane Liebschutz MD MPH1
1Department of General Internal Medicine, Boston University School of Medicine and Boston Medical Center;2Department of Community Health Sciences, Boston University School of Public Health
(n=113)
Supported by a grant from the CareFusion Foundation
