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. 2023 Nov 1;7(6):zrad136.
doi: 10.1093/bjsopen/zrad136.

Temporal trends and patterns in initial opioid prescriptions after hospital discharge following colectomy in England over 10 years

Reham M Baamer  1   2 , David J Humes  3   4 , Li Shean Toh  1 , Roger D Knaggs  1   5 , Dileep N Lobo  3   4   6   7
Affiliations

Temporal trends and patterns in initial opioid prescriptions after hospital discharge following colectomy in England over 10 years

Reham M Baamer et al. BJS Open. .

Abstract

Background: While opioid analgesics are often necessary for the management of acute postoperative pain, appropriate prescribing practices are crucial to avoid harm. The aim was to investigate the changes in the proportion of people receiving initial opioid prescriptions after hospital discharge following colectomy, and describe trends and patterns in prescription characteristics.

Methods: This was a retrospective cohort study. Patients undergoing colectomy in England between 2010 and 2019 were included using electronic health record data from linked primary (Clinical Practice Research Datalink Aurum) and secondary (Hospital Episode Statistics) care. The proportion of patients having an initial opioid prescription issued in primary care within 90 days of hospital discharge was calculated. Prescription characteristics of opioid type and formulation were described.

Results: Of 95 155 individuals undergoing colectomy, 15 503 (16.3%) received opioid prescriptions. There was a downward trend in the proportion of patients with no prior opioid exposure (opioid naive) who had a postdischarge opioid prescription (P <0.001), from 11.4% in 2010 to 6.7% in 2019 (-41.3%, P <0.001), whereas the proportions remained stable for those prescribed opioids prior to surgery, from 57.5% in 2010 to 58.3% in 2019 (P = 0.637). Codeine represented 44.5% of all prescriptions and prescribing increased by 14.5% between 2010 and 2019. Prescriptions for morphine and oxycodone rose significantly by 76.6% and 31.0% respectively, while tramadol prescribing dropped by 48.0%. The most commonly prescribed opioid formulations were immediate release (83.9%), followed by modified release (5.8%) and transdermal (3.2%). There was a modest decrease in the prescribing of immediate-release formulations from 86.0% in 2010 to 82.0% in 2019 (P <0.001).

Conclusion: Over the 10 years studied, there was a changing pattern of opioid prescribing following colectomy, with a decrease in the proportion of opioid-naive patients prescribed postdischarge opioids.

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Figures

Fig. 1
Fig. 1
Study flow diagram CPRD, Clinical Practice Research Datalink.
Fig. 2
Fig. 2
Temporal trend of percentage of patients who received opioid prescriptions after discharge
Fig. 3
Fig. 3
Yearly trend in the potency of opioid prescribed in initial prescription received after discharge a overall cohort, b cohort stratified by opioid exposure before colectomy and c cohort stratified by surgical approach.
Fig. 4
Fig. 4
Yearly trend in the type of opioid prescribed in initial prescription received after discharge a overall cohort, b cohort stratified by opioid exposure before colectomy and c cohort stratified by surgical approach.
Fig. 5
Fig. 5
Yearly trend in total oral morphine equivalent (OMEQ) doses prescribed in initial prescription received after discharge a overall cohort, b cohort stratified by opioid exposure before colectomy and c cohort stratified by surgical approach.
See this image and copyright information in PMC

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