Opioid Prescribing Practices and Patient Use in Minimally Invasive Surgery
*Danielle T. Friedman, *Saber Ghiassi, *Matthew Hubbard, Andrew J. Duffy
Yale University, New Haven, CT
Objective. Compare opioid prescribing practice for minimally invasive surgical procedures with self-reported patient use and pain control satisfaction
Setting. University hospital; ambulatory and short-stay surgery
Patients. All patients at initial postoperative visit were eligible. 35 declined or excluded for inpatient stay over 3 days. 150 patients were analyzed for 4 procedures: laparoscopic cholecystectomy (LC; n=47), laparoscopic inguinal hernia repair (LIHR; n=44), laparoscopic ventral hernia repair (LVHR; n=19), and laparoscopic paraesophageal hernia repair (LPEH; n=41). Overall, 53% female, average age of 57 years (range 20-89). 21.0% minority. 8.0 % had active preoperative narcotic prescriptions. 5 patients (3.3%) declined opioid prescription (1 with active baseline prescription).
Intervention. Survey administered at initial postoperative office visit.
Main Outcome Measures. Number of pills prescribed (verified number dispensed); proportion used; duration of opioid use; satisfaction with postoperative pain control; non-narcotic analgesic use.
Results. 19±9 pills dispensed for LC, 3.2 days of use; 23±10 pills for LIHR, 2.7 days; 31±10 pills for LVHR, 4.6 days; 27±11 pills for LPEH, 3.7 days. 52-72% reported retaining more than half or all of their opioids at the two-week visit (Figure). 75% utilized non-narcotic analgesics. Those patients showed a trend toward more adequate pain control (OR 1.31, 95% CI 0.47-3.6). Those on preoperative narcotics were significantly more likely to report inadequate pain control (OR 4.36, 95% CI 1.2-15.8). The average number of pills prescribed was higher in those with inadequate pain control (29 versus 23 pills, p = 0.04).
Conclusions. Opioid analgesics were overprescribed for the majority of our patients. More medication did not correlate with adequate pain control. We are using these data to standardize procedure-specific guidelines for opiate prescriptions in our practice.