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Wide Variation and Excessive Dosage of Narcotic Prescriptions for Common General Surgical Procedures
*Maureen V Hill1, *Michelle L McMahon2, *Ryland S Stucke1, Rick J Barth, Jr1
1Dartmouth Hitchcock Medical Center, Lebanon, NH;2Geisel School of Medicine, Hanover, NH
OBJECTIVE: With narcotic abuse rising, it behooves surgeons to limit the number of narcotics prescribed post-operatively. However, the imperative to give patients enough narcotics so they don’t need to return for a refill drives surgeons to prescribe an abundance of pills. Our objective was to evaluate current prescribing practices.
DESIGN: Chart review and phone survey.
SETTING: Academic medical center.
PATIENTS: We evaluated 642 patients undergoing 5 outpatient procedures: open inguinal hernia repair (IH), laparoscopic inguinal hernia repair (LIH), partial mastectomy (PM), partial mastectomy with sentinel lymph node biopsy (PM SLNB), and laparoscopic cholecystectomy (LC).
INTERVENTIONS:
MAIN OUTCOME MEASURES: Post-operative narcotic prescriptions and refill data. A phone survey was conducted to estimate the number of pills taken.
RESULTS: There was a wide variation in the number of narcotic pills prescribed to patients. For example, the median number of narcotics prescribed for LC was 30, range 0-100, 35% prescribed > 40 pills. For PM and PMSLN patients, the median was 20, 21% received none and 25% received > 30 pills.
Overall, only 27% of prescribed pills were taken. This percentage varied by operation: IH 55%, LIH 27%, LC 27%, PMSLN 21% and PM 7%.
We identified the number of pills that would fully supply the narcotic needs of 80% of patients undergoing each operation: IH 30, LIH 15, LC 15, PMSLN 10 and PM 0. If this number were prescribed, the number of narcotics initially prescribed would decrease by 55%.
CONCLUSIONS: There is wide variability in narcotic prescriptions for common general surgery procedures. In many cases excess pills are prescribed. It may be possible to decrease the number of narcotics prescribed with minimal effects on patient convenience.
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