To characterize differences in postoperative opioid prescribing
across surgical, nonsurgical, and advanced practice providers.
There is a critical need to identify best practices around perioperative opioid prescribing
. To date, differences in postoperative prescribing among providers are poorly understood.
This is a retrospective multicenter analysis of commercial insurance claims from a statewide quality collaborative. We identified 15,657 opioid
-naïve patients who underwent a range of surgical procedures between January 2012 and October 2015 and filled an opioid
prescription within 30 days postoperatively. Our primary outcome was total amount of opioid
filled per prescription within 30 days postoperatively [in oral morphine equivalents (OME)]. Hierarchical linear regression was used to determine the association between provider
, advanced practice providers (nurse practitioners and physician assistants) vs. physician, and gender] and outcome while adjusting for patient factors.
Average postoperative opioid
prescription amount was 326 ± 285 OME (equivalent: 65 tablets of 5 mg hydrocodone). Advanced practice providers accounted for 19% of all prescriptions, and amount per prescription was 18% larger in this group compared with physicians (315 vs. 268, P
< 0.001). Primary care providers accounted for 13% of all prescriptions and prescribed on average 279 OME per prescription. The amount of opioid
prescribed varied by surgical specialty
and ranged from 178 OME (urology) to 454 OME (neurosurgery).
Advanced practice providers account for 1-in-5 postoperative opioid
prescriptions and prescribe larger amounts per prescription relative to surgeons. Engaging all providers involved in postoperative care is necessary to understand prescribing practices, identify barriers to reducing prescribing, and tailor interventions accordingly.