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Is the Amount of Postoperative Opioid Pills Prescribed Reflect the Severity of Pain After Surgery? A Multicenter International Study
*Mohamad El Moheb1, *Ava Mokhtari1, *Kelsey Han1, *Inge van Erp1, *Napaporn Kongkaewpaisan2, *Zhenyi Jia3, *Gabriel Rodriguez1, *Manasnun Kongwibulwut4, *Joseph V. Sakran5, *Bellal Joseph6, *Camilo Ortega7, *Sonia Lopez Flores8, *Bernardo J. Gutierrez-Sougarret8, *Huanlong Qin9, *Jun Yang3, *Renyuan Gao10, *Zhiguo Wang11, *Zhiguang Gao10, *Supparerk Prichayudh12, *Gwendolyn van der Wilden13, *Napakadol Noppakunsomboom2, *Ramzi Alami14, Haytham Kaafarani1
1Massachusetts General Hospital, Harvard Medical School, Boston, MA;2Siriraj Hospital, Mahidol University, Bangkok, Thailand3Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China4Chulalongkorn University, Bangkok, Thailand5The Johns Hopkins University, Baltimore, MD;6University of Arizona, Tucson, AZ;7Hospital Departamental Villavicencio, Villavicencio, Colombia8Hospital Angeles Pedregal, Mexico City, Mexico9Shanghai Tenth People's Hospital, Shanghai, China10Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China11Changzheng Hospital, Navy Medical University, Shanghai, China12King Chulalongkorn Memorial Hospital, Bangkok, Thailand13Leiden University Medical Center, Leiden, Netherlands14American University of Beirut, Beirut, Lebanon

Objective: Excess opioid prescription contributes to the opioid epidemic by diversion of unused pills. We sought to assess the relationship between the amount of post-discharge opioid medications prescribed and pain severity after surgery. Design/Setting: Post-hoc analysis of the International Patterns of Opioid Prescribing (iPOP) multicenter study. Patients: Patients ≥16 years who underwent appendectomy, cholecystectomy, or inguinal herniorrhaphy between October 2016 and March 2017. Pain severity was recorded on a 0-10 visual analog scale at discharge and patients were stratified into four pain groups: none (0), mild (1-3), moderate (4-6) and severe (7-10). Intervention: N/A. Main outcome measures: Opioid prescriptions, oral morphine equivalents (OME), and number of pills were assessed across pain groups and a comparison between US and non-US patients was performed. Results: A total of 2,024 patients from 7 countries were included; the mean age was 49.8 (0.40) and 54% of patients were males. Opioid prescription rates, mean OME, and number of pills prescribed were similar across all 4 pain groups in US patients but increased in a stepwise fashion with higher pain severity in non-US patients (Figure 1). Conclusions: Unlike their non-US counterparts, US providers prescribe high amounts of opioids after surgery regardless of patients’ pain severity. Further efforts should be directed towards tailoring opioid prescriptions to patients’ needs and perceived pain.
Figure 1. Comparison of discharge pain management between US and non-US patients


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