A Guideline for Discharge Opioid Prescriptions after Inpatient General Surgical Procedures
*Maureen Hill, *Ryland Stucke, *Sarah Billmeier, *Julia Kelly, Richard Barth
Dartmouth-Hitchcock Medical Center, Lebanon, NH
OBJECTIVE: Evaluate discharge opioid prescribing practices and patient home opioid use after inpatient general surgical procedures. DESIGN: Patient survey. SETTING: Academic medical center. PATIENTS: 265 patients discharged home after hospital admission for bariatric, foregut, liver, pancreas, ventral hernia and colon surgery. INTERVENTIONS: Letter and phone survey. MAIN OUTCOME MEASURE: Home opioid use. RESULTS: Post-discharge opioid use information was obtained from 74% of patients. 44% of prescribed opioid pills were taken; <2% of patients required refills. When analyzed by operation type, there was no significant difference in the mean number of pills taken after discharge. 15 opioid pills satisfied the opioid needs of 80% of patients discharged on post-operative day (POD) 1 or 2. For patients discharged after POD 2, 60% took no opioids the day prior to discharge; 27% took 1-3 and 11% took 4 or more pills. For patients discharged after POD2, the number of pills taken was related to the number taken the day prior to discharge (Spearman correlation coefficient 0.53, p <0.0001). 80% of these patients’ home opioid requirements would be satisfied using the following guideline:
| Pills taken day prior to discharge | Discharge prescription pill number |
| 0 | 0 |
| 1-3 | 10 |
| 4+ | 30 |
If these guidelines were used, the number of opioid pills prescribed would be decreased by 35% for patients discharged on POD 1-2 and by 57% for patients discharged after POD 2. CONCLUSIONS: For patients undergoing surgeries which require hospital admission, post-discharge opioid use is better determined by inpatient opioid use than by operation type. Utilization of a proposed guideline could decrease opioid prescriptions by half and effectively treat patients’ pain.
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