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Wide Variation and Overprescription of Opioids After Elective Surgery

Thiels, Cornelius A. DO, MBA*,†; Anderson, Stephanie S. BS; Ubl, Daniel S. MPH; Hanson, Kristine T. MPH; Bergquist, Whitney J. PharmD, RPh§; Gray, Richard J. MD, FACS; Gazelka, Halena M. MD||; Cima, Robert R. MD, MA, FACS, FASCRS*,†; Habermann, Elizabeth B. MPH, PhD

doi: 10.1097/SLA.0000000000002365

Objective: We aimed to identify opioid prescribing practices across surgical specialties and institutions.

Background: In an effort to minimize the contribution of prescription narcotics to the nationwide opioid epidemic, reductions in postoperative opioid prescribing have been proposed. It has been suggested that a maximum of 7 days, or 200 mg oral morphine equivalents (OME), should be prescribed at discharge in opioid-naïve patients.

Methods: Adults undergoing 25 common elective procedures from 2013 to 2015 were identified from American College of Surgeons National Surgical Quality Improvement Program data from 3 academic centers in Minnesota, Arizona, and Florida. Opioids prescribed at discharge were abstracted from pharmacy data and converted into OME. Wilcoxon Rank-Sum and Kruskal-Wallis tests assessed variations.

Results: Of 7651 patients, 93.9% received opioid prescriptions at discharge. Of 7181 patients who received opioid prescriptions, a median of 375 OME (interquartile range 225–750) were prescribed. Median OME varied by sex (375 men vs 390 women, P = 0.002) and increased with age (375 age 18–39 to 425 age 80+, P < 0.001). Patients with obesity and patients with non-cancer diagnoses received more opioids (both P < 0.001). Subset analysis of the 5756 (75.2%) opioid-naïve patients showed the majority received >200 OME (80.9%). Significant variations in opioid prescribing practices were seen within each procedure and between the 3 medical centers.

Conclusions: The majority of patients were overprescribed opioids. Significant prescribing variation exists that was not explained by patient factors. These data will guide practices to optimize opioid prescribing after surgery.

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*Department of Surgery, Mayo Clinic, Rochester, MN

Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN

Department of Health Services Research, Mayo Clinic, Rochester, MN

§Department of Pharmacy, Mayo Clinic, Rochester, MN

Department of Anesthesiology, Mayo Clinic, Rochester, MN

||Department of Surgery, Mayo Clinic, Scottsdale, AZ.

Reprints: Elizabeth B. Habermann, MPH, PhD, Mayo Clinic, 200 First St SW, Rochester, MN 55905. E-mail:

The work was presented as an oral presentation at the 137th American Surgical Association (ASA) Annual Meeting being held April 20–22, 2017 in Philadelphia, PA.

The authors report no conflicts of interest.

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