Association of Opioid Prescribing With Opioid Consumption After Surgery in Michigan

Abstract

Importance: There is growing evidence that opioids are overprescribed following surgery. Improving prescribing requires understanding factors associated with opioid consumption.

Objective: To describe opioid prescribing and consumption for a variety of surgical procedures and determine factors associated with opioid consumption after surgery.

Design, setting, and participants: A retrospective, population-based analysis of the quantity of opioids prescribed and patient-reported opioid consumption across 33 health systems in Michigan, using a sample of adults 18 years and older undergoing surgery. Patients were included if they were prescribed an opioid after surgery. Surgical procedures took place between January 1, 2017, and September 30, 2017, and were included if they were performed in at least 25 patients.

Exposures: Opioid prescription size in the initial postoperative prescription.

Main outcomes and measures: Patient-reported opioid consumption in oral morphine equivalents. Linear regression analysis was used to calculate risk-adjusted opioid consumption with robust standard errors.

Results: In this study, 2392 patients (mean age, 55 years; 1353 women [57%]) underwent 1 of 12 surgical procedures. Overall, the quantity of opioid prescribed was significantly higher than patient-reported opioid consumption (median, 30 pills; IQR, 27-45 pills of hydrocodone/acetaminophen, 5/325 mg, vs 9 pills; IQR, 1-25 pills; P < .001). The quantity of opioid prescribed had the strongest association with patient-reported opioid consumption, with patients using 0.53 more pills (95% CI, 0.40-0.65; P < .001) for every additional pill prescribed. Patient-reported pain in the week after surgery was also significantly associated with consumption but not as strongly as prescription size. Compared with patients reporting no pain, patients used a mean (SD) 9 (1) more pills if they reported moderate pain and 16 (2) more pills if they reported severe pain (P < .001). Other significant risk factors included history of tobacco use, American Society of Anesthesiologists class, age, procedure type, and inpatient surgery status. After adjusting for these risk factors, patients in the lowest quintile of opioid prescribing had significantly lower mean (SD) opioid consumption compared with those in the highest quintile (5 [2] pills vs 37 [3] pills; P < .001).

Conclusions and relevance: The quantity of opioid prescribed is associated with higher patient-reported opioid consumption. Using patient-reported opioid consumption to develop better prescribing practices is an important step in combating the opioid epidemic.

Figure 1.. Cohort of Patients Reporting Opioid Use After Surgery

Patients at 33 health systems were surveyed for patient-reported outcomes (PROs). ^aIn this pilot project, each health system was allowed to determine their own sampling algorithm to fit their unique and fluctuating workload; health systems did not report the total number of patients contacted.

Figure 2.. Opioid Prescription Size and Consumption

Median opioid prescription size and patient-reported consumption for all 12 procedures in tablets of hydrocodone/acetaminophen, 5/325 mg. Quantity of opioid prescribed was significantly greater than patient consumption for all procedures.

Figure 3.. Association of Opioid Consumption With Opioid Prescription Size

Risk-adjusted opioid consumption at the mean of each prescription size quintile in this cohort. Amount of opioid consumed and amount of opioid prescribed are represented as tablets of acetaminophen/hydrocodone, 5/325 mg. Mean quintile values are 17 tablets (range, 2-20), 29 tablets (range, 21-30), 36 tablets (range, 34-38), 42 tablets (range, 40-45), and 77 tablets (range, 48-384), respectively. Error bars show 95% confidence intervals for each mean. Amount of opioid consumed increased significantly at each quintile of prescription size.