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What evidence is needed to inform postoperative opioid consumption guidelines? A cohort study of the Michigan Surgical Quality Collaborative
  1. Jiyeon Song1,
  2. Yi Li1,
  3. Jennifer F Waljee2,3,
  4. Vidhya Gunaseelan3,4,
  5. Chad M Brummett3,4,
  6. Michael J Englesbe2,3 and
  7. Mark C Bicket3,4,5
  1. 1Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
  2. 2Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
  3. 3Opioid Prescribing Engagement Network, Institute for Health Policy and Innovation, Ann Arbor, MI, USA
  4. 4Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
  5. 5Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
  1. Correspondence to Dr Mark C Bicket, Anesthesiology, University of Michigan Michigan Medicine, Ann Arbor, MI 48109, USA; mbicket{at}med.umich.edu

Abstract

Introduction To balance adequate pain management while minimizing opioid-related harms after surgery, opioid prescribing guidelines rely on patient-reported use after surgery. However, it is unclear how many patients are required to develop precise guidelines. We aimed to compare patterns of use, required sample size, and the precision for patient-reported opioid consumption after common surgical procedures.

Methods We analyzed procedure-specific 30-day opioid consumption data reported after discharge from 15 common surgical procedures between January 2018 and May 2019 across 65 hospitals in the Michigan Surgical Quality Collaborative. We calculated proportions of patients using no pills and the estimated number of pills meeting most patients’ needs, defined as the 75th percentile of consumption. We compared several methods to model consumption patterns. Using the best method (Tweedie), we calculated sample sizes required to identify opioid consumption within a 5-pill interval and estimates of pills to meet most patients’ needs by calculating the width of 95% CIs.

Results In a cohort of 10,688 patients, many patients did not consume any opioids after all types of procedures (range 20%–40%). Most patients’ needs were met with 4 pills (thyroidectomy) to 13 pills (abdominal hysterectomy). Sample sizes required to estimate opioid consumption within a 5-pill wide 95% CI ranged from 48 for laparoscopic appendectomy to 188 for open colectomy. The 95% CI width for estimates ranged from 0.7 pills for laparoscopic cholecystectomy to 7.0 pills for ileostomy/colostomy.

Conclusions This study demonstrates that profiles of opioid consumption share more similarities than differences for certain surgical procedures. Future investigations on patient-reported consumption are required for procedures not currently included in prescribing guidelines to ensure surgeons and perioperative providers can appropriately tailor recommendations to the postoperative needs of patients.

  • Pain, Postoperative
  • Analgesics, Opioid
  • Acute Pain

Data availability statement

Data may be obtained from a third party and are not publicly available. Data may be obtained from the Michigan Surgical Quality Collaborative.

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Data availability statement

Data may be obtained from a third party and are not publicly available. Data may be obtained from the Michigan Surgical Quality Collaborative.

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Footnotes

  • Twitter @drchadb, @MarkBicket

  • Contributors JS helped design the study, acquire, analyze, and interpret the data, draft the initial manuscript, and critically revise the manuscript, and serves as the guarantor. YL helped design the study, draft the initial manuscript, and critically revise the manuscript. JFW helped interpret the data and critically revise the manuscript. VG helped acquire, analyze, and interpret the data, and critically revise the manuscript. CMB helped interpret the data and critically revise the manuscript. MJE helped interpret the data and critically revise the manuscript. MCB helped design the study, interpret the data, draft the initial manuscript, and critically revise the manuscript.

  • Funding This work was funded by the National Institute on Drug Abuse (R01DA042859).

  • Disclaimer No funder or sponsor had any role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.

  • Competing interests JS, YL, and VG have no disclosures. CMB, MJE, JFW, and MCB receive funding from the Michigan Department of Health and Human Services and the National Institute on Drug Abuse (R01DA042859). CMB is a consultant for Heron Therapeutics, Vertex Pharmaceuticals, Alosa Health and the Benter Foundation, not related to this work. JS had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

  • 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.