Opioid and non-opioid utilization at home following gastrointestinal procedures: a prospective cohort study
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.
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.
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.
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.
KeywordsPain Analgesics, opioid Digestive system surgical procedures Self-report Patient discharge
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
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.
- 1.McCaffery M, Pasero CL (1997) Pain ratings: the fifth vital sign. Am J Nurs 97:15–16Google Scholar
- 2.Centers for Disease Control and Prevention (2011) Vital signs: overdoses of prescription opioid pain relievers—United States, 1999-2008. MMWR Morb Mortal Wkly Rep 60:1487–1492Google Scholar
- 15.Aryaie AH, Lalezari S, Sergent WK, Puckett Y, Juergens C, Ratermann C, Ogg C (2018) Decreased opioid consumption and enhance recovery with the addition of IV Acetaminophen in colorectal patients: a prospective, multi-institutional, randomized, double-blinded, placebo-controlled study (DOCIVA study). Surg Endosc 32:3432–3438CrossRefGoogle Scholar
- 17.Jones RS, Stukenborg GJ (2017) Patient-Reported Outcomes Measurement Information System (PROMIS) use in surgical care: a scoping study. J Am Coll Surg 224(245–254):e241Google Scholar
- 29.Thiele RH, Rea KM, Turrentine FE, Friel CM, Hassinger TE, Goudreau BJ, Umapathi GA, Kron IL, Sawyer RG, Hedrick TL (2015) Standardization of care: impact of an enhanced recovery protocol on length of stay, complications, and direct costs after colorectal surgery. J Am Coll SurgGoogle Scholar
- 30.Derry CJ, Derry S, Moore RA (2013) Single dose oral ibuprofen plus paracetamol (acetaminophen) for acute postoperative pain. Cochrane Database Syst Rev 6:CD010210Google Scholar