This article is more than 5 years old. Information may no longer be current.

Recommended postoperative opioid prescription timelines should differ by procedure

The length of time for opioid prescriptions after surgery should vary depending on the type of procedure, according to research recently published in JAMA Surgery.

“The overprescription of pain medications has been implicated as a driver of the burgeoning opioid epidemic; however, few guidelines exist regarding the appropriateness of opioid pain medication prescriptions following surgery,” Rebecca E. Scully, MD, of the division of vascular and endovascular surgery at Brigham and Women’s Hospital, Harvard Medical School in Boston, and colleagues wrote.

To gather more data on the subject, researchers identified 215,140 opioid-naïve individuals between 18 and 64 years of age from the Department of Defense Military Health System Data Repository. These participants had previously undergone one of eight surgical procedures and had at least one opioid prescription filled within 14 days after surgery. Scully and colleagues then modeled the adjusted risk for refilling an opioid prescription based on the number of days of initial prescription using a generalized additive model with spline smoothing.

Researchers found that 19.1% of patients received at least one prescription refill. The median prescription lengths were 4 days for hysterectomy; 4 days for appendectomy and cholecystectomy; 5 days for inguinal hernia repair; 5 days for mastectomy; 5 days for rotator cuff repair and anterior cruciate ligament repair; and 7 days for discectomy.

In addition, the lowest point in the likelihood of refill was 15 days for musculoskeletal operations (likelihood of refill, 32.5%), 13 days for women’s health operations (likelihood of refill, 16.8%) and 9 days for general operations (likelihood of refill, 10.7%).

“Ideally, opioid prescriptions after surgery should balance adequate pain management against the duration of treatment. In practice, the optimal length of opioid prescriptions lies between the observed median prescription length and the early nadir, or 4 to 9 days for general surgery procedures, 4 to 13 days for women’s health procedures, and 6 to 15 days for musculoskeletal procedures,” Scully and colleagues wrote.

In a related editorial, Selwyn O. Rogers Jr., MD, MPH, of the department of surgery at the University of Chicago Medicine, encouraged health care professionals to remind patients that a complete elimination of pain may not always be possible.

“Unfortunately, we have reached a point that 100% elimination of pain has become not only the goal but the expectation. If a surgeon allows a patient to expect a pain-free recovery, he or she will see refill requests increase,” he wrote.

“Alternatives to narcotics should be recommended and incorporated as the foundation of pain management,” Rogers continued. “It does not take much time to explain the use of acetaminophen and ibuprofen and then follow up with a stronger option if the pain is not adequately relieved. It is also useful to prepare the patient to expect some discomfort, realize that complete relief of all pain is impossible, and that the cost of trying is not worth it. Beyond the itching, nausea, constipation and nightmares associated with opiate medications are addiction and death. We should do our part to alleviate this burden on our patients.” – by Janel Miller

Disclosures: The authors report no relevant financial disclosures.