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Opioid and non-opioid utilization at home following gastrointestinal procedures: a prospective cohort study

  • Karsten BartelsEmail author
  • Katharine Mahoney
  • Kristen M. Raymond
  • Shannon K. McWilliams
  • Ana Fernandez-Bustamante
  • Richard Schulick
  • Christian J. Hopfer
  • Susan K. Mikulich-Gilbertson
Article

Abstract

Background

Overprescribing of opioid medications for patients to be used at home after surgery is common. We sought to ascertain important patient and procedural characteristics that are associated with low versus high rates of self-reported utilization of opioids at home, 1–4 weeks after discharge following gastrointestinal surgery.

Methods

We developed a survey consisting of questions from NIH PROMIS tools for pain intensity/interference and queries on postoperative analgesic use. Adult patients completed the survey weekly during the first month after discharge. Using regression procedures we determined the patient and procedure characteristics that predicted high post-discharge opioid use operationalized as 75 mg oral morphine equivalents/50 mg oxycodone reported taken.

Results

The survey response rate was 86% (201/233). High opioid use was reported by 52.7% of patients (106/201). Median reported intake of opioid pain pills was 7 for week #1 and 0 for weeks #2–4. Combinations of acetaminophen and non-steroidal and anti-inflammatory drugs were used by 8.9%–12.5% of patients after discharge. Following adjustment for significant variables of the univariate analysis, last 24-h in-hospital opioid intake remained as a significant co-variate for post-discharge opioid intake.

Conclusions

After gastrointestinal surgery, the equivalent of each oxycodone 5 mg tablet taken in the last 24 h before discharge increases the likelihood of taking the equivalent of > 10 oxycodone 5 mg tablets by 5%. Non-opioid analgesia was utilized in less than half of the cases. Maximizing non-opioid analgesic therapy and basing opioid prescriptions on 24-h pre-discharge opioid intake may improve the quality of post-discharge pain management.

Keywords

Pain Analgesics, opioid Digestive system surgical procedures Self-report Patient discharge 

Notes

Funding

This work was supported by the National Institutes of Health (NIH), Award Number K23DA040923 to Karsten Bartels and NIH Award Number UL1TR002535. The content of this report is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. The NIH had no involvement in study design, collection, analysis, interpretation of data, writing of the report, or the decision to submit the article for publication.

Compliance with ethical standards

Disclosures

Karsten Bartels, M.D, Ph.D., reports grants from National Institutes of Health during the conduct of the study. Katharine Mahoney, Kristen M. Raymond, Shannon K. McWilliams, Ana Fernandez-Bustamante, Richard Schulick, Christian J. Hopfer, and Susan K. Mikulich Gilbertson have no conflicts of interest or financial ties to disclose.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Karsten Bartels
    • 1
    • 2
    • 3
    Email author
  • Katharine Mahoney
    • 3
  • Kristen M. Raymond
    • 3
  • Shannon K. McWilliams
    • 3
  • Ana Fernandez-Bustamante
    • 2
  • Richard Schulick
    • 1
  • Christian J. Hopfer
    • 3
  • Susan K. Mikulich-Gilbertson
    • 3
    • 4
  1. 1.Department of SurgeryUniversity of Colorado/Anschutz Medical CampusAuroraUSA
  2. 2.Department of AnesthesiologyUniversity of Colorado/Anschutz Medical CampusAuroraUSA
  3. 3.Department of PsychiatryUniversity of Colorado/Anschutz Medical CampusAuroraUSA
  4. 4.Department of Biostatistics & InformaticsUniversity of Colorado/School of Public HealthAuroraUSA

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