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  • Postoperative opioid prescribing, use and pain trends following general surgery procedures: a retrospective cohort study among veterans comparing non-opioid versus chronic opioid users

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Original research
Postoperative opioid prescribing, use and pain trends following general surgery procedures: a retrospective cohort study among veterans comparing non-opioid versus chronic opioid users
  1. Josh Bleicher1,
  2. Benjamin Sands Brooke1,2,
  3. Kimberlee Bayless3,
  4. Zachary Anderson3,
  5. Julie Beckstrom1,
  6. Chong Zhang4,
  7. Angela P Presson4,
  8. Lyen C Huang1 and
  9. Michael Jacob Buys5,6
  1. 1 Surgery, University of Utah Health Hospitals and Clinics, Salt Lake City, Utah, USA
  2. 2 Surgery, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
  3. 3 Anesthesiology, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
  4. 4 Internal Medicine-Epidemiology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
  5. 5 Anesthesiology, University of Utah Health Hospitals and Clinics, Salt Lake City, Utah, USA
  6. 6 Anesthesia, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
  1. Correspondence to Dr Michael Jacob Buys, Anesthesiology, University of Utah Health Hospitals and Clinics, Salt Lake City, UT 84132, USA; michael.buys{at}hsc.utah.edu

Abstract

Introduction Understanding postoperative opioid use patterns among different populations is key to developing opioid stewardship programs.

Methods We performed a retrospective cohort study on opioid prescribing, use, and pain after general surgery procedures for patients cared for by a transitional pain service at a veterans administration hospital. Discharge opioid prescription quantity, 90-day opioid prescription, and patient reported outcome pain measures were compared between chronic opioid users and non-opioid users (NOU). Additionally, 90-day total opioid use was evaluated for NOU.

Results Of 257 patients, 34 (13%) were on chronic opioid therapy, over 50% had a mental health disorder, and 29% had a history and/or presence of a substance use disorder. NOU were prescribed a median (IQR) of 10 (7, 12) tablets at discharge, while chronic opioid users were prescribed 6 (0, 12) tablets (p<0.001). 90-day opioid prescription (not including baseline opioid prescription for chronic users) was 10 (7, 15) and 6 (0, 12) tablets, respectively (p=0.001). There were no differences in changes in pain intensity or pain interference scores during recovery between groups. Median 90-day opioid use post discharge for NOU was 4 (0, 10) pills.

Discussion Non-opioid and chronic opioid users required very few opioid pills following surgery, and patients on chronic opioid therapy quickly returned to their baseline opioid use after a small opioid prescription at discharge. There was no difference in pain recovery between groups. Opioid prescribing guidelines should include patients on chronic opioid therapy and could consider recommending a more conservative prescribing approach.

  • Analgesics, Opioid
  • Pain, Postoperative
  • Acute Pain
  • Pain Measurement

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/rapm-2021-103382

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • Twitter @BenjaminSBrooke, @DrKimBaylessNP

    • Contributors MJB is the guarantor of this study. All authors contributed to the design, data analysis, and interpretation of the study and drafted and revised the manuscript.

    • Funding This work was supported by Veterans Health Administration Office of Rural Health (ORH), VA Salt Lake City Health Care System (ORH Project #14434), and the University of Utah Population Health Research Foundation, with funding in part from the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Numbers UL1TR002538 and KL2TR002539. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Federal Government or the National Institutes of Health.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.