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Panel creates opioid prescription guidelines for common procedures including orthopedic surgeries
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Among opioid-prescribing guidelines for 20 common surgeries created by a panel of health care providers and patients from the John Hopkins Health System, panelists recommended a range of zero to 20 pills for three out of four orthopedic surgeries evaluated, which was the highest range of opioids among the eight health care specialties reviewed, according to a release from John Hopkins Medicine.
“Over-prescribing after surgery has been a contributor to the opioid crisis, with new research showing that most patients don’t need most of the pills they are prescribed,” Martin A. Makary, MD, MPH, FACS, a professor of surgery and health policy expert at the Johns Hopkins University School of Medicine and the senior author of the study, told Healio.com/Orthopedics. “The recommendations by the Hopkins expert group is a first step toward creating a consensus around best practices.”
To the knowledge of the panel, the guidelines are the first set of operation-specific opioid prescribing guidelines in the United States, according to the release.
“Prescriptions for pain meds after surgery should be custom tailored to the operation and a patient’s needs and goals, but the hope is that these guidelines will help reset ‘defaults’ that have been dangerously high for too long,” Makary said in the release.
According to the study, which appears in the Journal of the American College of Surgeons, researchers asked 30 surgeons, pain specialists, outpatient surgical nurse practitioners, surgical residents, patients and pharmacists to recommend an appropriate number of opioids to prescribe based on oxycodone 5-mg oral equivalents. Panelists were to assume operations were uncomplicated and patients did not have chronic pain unrelated to the procedure. Twenty common procedures in orthopedic surgery, breast surgery, thoracic surgery and cardiac surgery were reviewed by the panel. Arthroscopic ACL/PCL repair, arthroscopic rotator cuff repair and open reduction and internal fixation of the ankle were among the orthopedic surgeries reviewed.
According to the study, the panel agreed the minimum number in the opioid tablet range should be zero for all 20 procedures reviewed; although they acknowledged that postoperative pain was rarely managed with non-opioid medication alone at the time of discharge for some procedures.
The panelists recommended that the maximum number of opioid tablets varied by procedure, with one to 15 tablets for 11 out of the 20 procedures reviewed; 16 to 20 tablets for six out of 20 procedures; and zero tablets for three out of the 20 procedures. They recommended ibuprofen for all patients except when medically contradicted. Patients who underwent the procedures voted for fewer opioids compared to the number of opioids voted for by the surgeons who performed the procedures.
“Anywhere in range agreed upon by the panel represents a major improvement from current practice.” Makary said in the release.
Makary added, “It’s unfortunate guidelines haven’t already existed. Giving patients dangerous opioid pills they don’t need is part of how we got into this opioid crisis in the first place.” - by Monica Jaramillo
References:
Overton HN, et al. J Am Coll Surg.2018;doi:10.1016/j.jamcollsurg.2018.07.659.
www.hopkinsmedicine.org/
Disclosures: Overton reports she was supported in part by NIH 5T32CA126607-09. Please see the full study for a list of all other authors’ relevant financial disclosures.