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Opioids may be overprescribed after EVAR
Among patients who underwent endovascular aneurysm repair, more opioids were prescribed than consumed, suggesting they may be overprescribed, researchers reported at the Society for Vascular Surgery Vascular Annual Meeting.
In a separate report, the same team of researchers found patients who had EVAR were more likely to be prescribed opioids at discharge if they had used them during their hospital stay.
Prescription vs. consumption
For the volume-related analysis, Mark D. Balceniuk, MD, resident at the University of Rochester, and colleagues assessed the difference between the frequency of opioid prescription vs. opioid consumption in 40 patients (mean age, 71 years; 75% men) who underwent EVAR and were documented to have at least one opioid prescription. Consumption was determined by telephone surveys.
Although 1,185 pills (29.6 per patient) were prescribed, only 208 pills (5.2 per patient) were consumed, and 82% of prescribed pills were never consumed while 58% of patients consumed no pills, according to the researchers.
Only two patients requested refills, and one request was granted, the researchers found.
Balceniuk also evaluated pill consumption based on access approach. Among those who had bilateral percutaneous access, 79% of pills went unconsumed, and among those who had open access, 90% of pills went unconsumed.
“We demonstrate that patients consume much fewer opioids than prescribed,” Balceniuk and colleagues wrote in an abstract. “These findings add to the growing body of literature indicating that opioids are overprescribed following surgical procedures. Adoption of minimal access procedures should translate to cessation of discharge oral narcotic analgesics.”
Inpatient use
In the second study, Balceniuk and colleagues evaluated the association of inpatient use of opioids with receiving an opioid prescription at discharge among 171 patients who underwent elective EVAR between 2015 and 2018.
Among the cohort, 100 patients did not receive an opioid prescription at discharge (mean age, 75 years; 86% men) while 71 patients did (mean age, 71 years; 83% men; P = .005 for age difference).
Among those who did not receive opioids in the hospital, 45% were given an opioid prescription at discharge compared with 79% of those who had in-hospital opioids (P < .001), the researchers found.
Patients who received opioids at discharge received more oral morphine equivalents during their hospital stay compared with patients not prescribed opioids at discharge (10.05 vs. 27.76; P < .001), Balceniuk and colleagues reported.
Independent predictors of being discharged with an opioid prescription included younger age (OR per 10 years = 0.65; 95% CI, 0.43-0.98), estimated blood loss (OR per 100 mL = 1.26; 95% CI, 1.01-1.57) and greater use of inpatient oral morphine equivalents (OR per 10 mg = 1.2; 95% CI, 1.01-1.42), according to the researchers.
“These data demonstrate that there is a relationship between inpatient opioid use and outpatient prescription following EVAR,” the researchers wrote in an abstract. “This study indicates factors associated with a need for outpatient opioid prescriptions. These findings provide insight as to which patients may not require an outpatient prescription following EVAR, leading to practice-changing opioid reduction strategies.” – by Erik Swain
References:
Balceniuk MD, et al. Abstract IP065.
Balceniuk MD, et al. Abstract IP067. Both presented at: Society for Vascular Surgery Vascular Annual Meeting; June 12-15, 2019; National Harbor, Md.
Disclosures: The authors report no relevant financial disclosures.