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Results of a Prospective, Multicenter Initiative Aimed at Developing Opioid-prescribing Guidelines After Surgery

Thiels, Cornelius A. DO, MBA*,†; Ubl, Daniel S. MPH†,‡; Yost, Kathleen J. PhD‡,§; Dowdy, Sean C. MD; Mabry, Tad M. MD||; Gazelka, Halena M. MD**; Cima, Robert R. MD, MA, FACS, FASCRS*,†; Habermann, Elizabeth B. MPH, PhD*,†,‡

doi: 10.1097/SLA.0000000000002919

Objective: The aim of this study was to conduct a prospective, multicenter survey of patients regarding postoperative opioid use to inform development of standardized, evidence-based, procedure-specific opioid prescribing guidelines.

Summary of Background Data: Previous work has shown significant variation in the amount of opioids prescribed after elective procedures, calling for optimization of prescribing.

Methods: Adults (n = 3412) undergoing 25 elective procedures were identified prospectively from 3 academic centers (March 2017 to January 2018) to complete a 29-question telephone interview survey 21 to 35 days post-discharge (n = 688 not contacted, n = 107 refused). Discharge opioids were converted into Morphine Milligram Equivalents (MMEs).

Results: Of the 2486 patients who completed the survey, 91.2% received opioids at discharge [median 225 (interquartile range, IQR 125 to 381) MME]. A median of 43 (0 to 184) MMEs were consumed after discharge with 77.3% of patients having leftover opioids at the time of the survey. In total, 61.5% of prescribed opioids were unused; 31.4% of patients used no opioids, and 52.6% required <50 MME. Overall, 90.6% of patients were satisfied with their postdischarge pain control. While 28.3% reported being prescribed too many opioids, 9.0% felt they were not prescribed enough. Only 9.6% of patients disposed of remaining opioids. Of the 2068 opioid-naive respondents (83.2%), 33.6% consumed no opioids (range 5.2% to 80.0% by procedure) and 57.0% (65.7% nonorthopedic) consumed <50 MME. Utilization data and predictors of low/high opioid consumption informed development of postoperative prescribing guidelines.

Conclusion: A large proportion of postoperative patients reported using no or few opioids following discharge. Guidelines were developed to minimize opioid prescribing and identify patients requiring low doses or additional multimodal pain control.

*Department of Surgery, Mayo Clinic, Rochester, MN

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

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

§Survey Research Center, Mayo Clinic, Rochester, MN

Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN

||Department of Orthopedics, Mayo Clinic, Rochester, MN

**Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.

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

This work has not previously or concurrently been submitted for publication. The work was presented as an oral presentation at the 138th American Surgical Association (ASA) Annual Meeting being held April 19 to 21, 2018, in Phoenix, AZ.

Financial support was provided internally by the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery and the Mayo Clinic Department of Surgery.

The authors have no relevant financial disclosures.

The authors declare no conflict of interests.

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