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Post-discharge Opioid Use After General and Orthopedic Surgery
*Mayo H. Fujii1, *Ashley C. Hodges2, *Ruby L. Russell2, *Kristin Roensch1, *Bruce Beynnon2, *Thomas P. Ahern2, *Jesse S. Moore1, *S. Elizabeth Ames1, *Charles D. MacLean1
1University of Vermont Medical Center, Burlington, VT;2University of Vermont Larner College of Medicine, Burlington, VT

OBJECTIVE: To identify the amount of opioid used after common surgeries and whether patients received non-opioid pain management and opioid disposal instructions.
DESIGN: Survey and retrospective chart review of patients 5-7 days after discharge with possible follow-up one week later.
SETTING: A 340-bed academic medical institution.
PATIENTS: Consecutive sample of general and orthopedic surgery patients. We enrolled 559 patients meeting the following eligibility criteria: one of ten most common procedures, age 18 years or older, uncomplicated recovery. Of these, 243 were excluded for refusal to participate, inability to communicate by phone or complication after enrollment. Data were collected on 304 patients.
INTERVENTIONS: A 10-minute telephone survey inquiring about amount of opioid used and discharge instructions. Prescription details were obtained by chart review.
MAIN OUTCOME MEASURE: Proportion of opioid prescription used, calculated using standard morphine milligram equivalent (MME) dose conversions.
RESULTS: Response rate was 58% and 93% of patients received an opioid. Most commonly prescribed opioids were oxycodone (44%) and hydromorphone (44%). Median proportion of opioid used was 26% of the prescribed amount, or 38 MMEs, across all procedures. Only 21% of patients received instructions on medication disposal and 84% received instructions on non-opioid pain management. Results not listed here include additional patient demographics and procedure-specific findings (Table).
CONCLUSIONS: Many patients were instructed on non-opioid pain management and used less than 30% of the opioid prescribed after surgery, however few patients received instructions on proper disposal of excess opioid medication. Informed prescribing and disposal practices would minimize unused opioid in the community.

Table. Patient-reported opioid use after common general and orthopedic surgeries
Opioid Used (proportion)Opioid Used (MME)
ProcedureN25th percentile50th percentile75th percentileN25th percentile50th percentile75th percentile
All subjects27300.260.80260038120
Inguinal hernia repair230.130.501.0022166496
Umbilical hernia repair190.000.200.70160939
Appendectomy, laparoscopic160.000.180.711602364
Cholecystectomy, laparoscopic390.000.200.683902580
Colectomy, laparoscopic50.000.000.005000
Colectomy, open20.000.000.002000
Partial mastectomy180.000.000.40170024
Hip arthroplasty420.000.310.9042082300
Knee arthroplasty310.030.501.00308135347
Knee arthroscopy/repair310.050.501.0029897150
Shoulder arthroscopy/repair270.150.250.672560122281
Carpal tunnel release170.000.070.60170530
Trigger finger release30.000.200.300------
MME: Morphine Milligram Equivalents


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