Evidence-based opioid prescribing guidelines after lung resection: a prospective, multicenter analysis

Abstract

Background: Opioid prescribing guidelines have significantly decreased overprescribing and post-discharge use after cardiac surgery; however, limited recommendations exist for general thoracic surgery patients, a similarly high-risk population. We examined opioid prescribing and patient-reported use to develop evidence-based, opioid prescribing guidelines after lung cancer resection.

Methods: This prospective, statewide, quality improvement study was conducted between January 2020 to March 2021 and included patients undergoing surgical resection of a primary lung cancer across 11 institutions. Patient-reported outcomes at 1-month follow-up were linked with clinical data and Society of Thoracic Surgery (STS) database records to characterize prescribing patterns and post-discharge use. The primary outcome was quantity of opioid used after discharge; secondary outcomes included quantity of opioid prescribed at discharge and patient-reported pain scores. Opioid quantities are reported in number of 5-mg oxycodone tablets (mean ± standard deviation).

Results: Of the 602 patients identified, 429 met inclusion criteria. Questionnaire response rate was 65.0%. At discharge, 83.4% of patients were provided a prescription for opioids of mean size 20.5±13.1 pills, while patients reported using 8.2±13.0 pills after discharge (P<0.001), including 43.7% who used none. Those not taking opioids on the calendar day prior to discharge (32.4%) used fewer pills (4.4±8.1 vs. 11.7±14.9, P<0.001). Refill rate was 21.5% for patients provided a prescription at discharge, while 12.5% of patients not prescribed opioids at discharge required a new prescription before follow-up. Pain scores were 2.4±2.5 for incision site and 3.0±2.8 for overall pain (scale 0-10).

Conclusions: Patient-reported post-discharge opioid use, surgical approach, and in-hospital opioid use before discharge should be used to inform prescribing recommendations after lung resection.

Keywords: Opioid prescribing; lung cancer; practice guidelines; thoracic surgery.

Figure 1

Patient population diagram with sequential exclusions. REDCap, Research Electronic Data Capture; STS, Society of Thoracic Surgeons.

Figure 2

Distribution of patient-reported opioid use after discharge.

Figure 3

Association between in-hospital use prior to discharge with patient-reported opioid use after discharge. (A) In-hospital opioid use prior to discharge, (B) average, and (C) distribution of patient-reported opioid use after discharge for patients taking (blue) or not taking (grey) opioids on the calendar day prior to discharge.

Figure 4

Opioid prescribing, pain adjuncts, and patient safety recommendations for opioid-naïve patients undergoing lung resection in conjunction with the Michigan Opioid Prescribing Engagement Network (https://michigan-open.org).