New England Surgical Society

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Opioid Prescription and Use Patterns Following Two Common Acute Care Surgery Procedures: Is Less More?
*Mayo H. Fujii1, Ajai K. Malhotra1, *Ethan Jones1, *Thomas P. Ahern2, *Loic Fabricant1, *Christos Colovos1
1University of Vermont Medical Center, Burlington, VT;2University of Vermont Larner College of Medicine, Burlington, VT

Objective: To describe opioid prescribing and use following two common acute care surgery (ACS) procedures - laparoscopic appendectomy (LA) and laparoscopic cholecystectomy (LC).
Design: Patient telephone survey data obtained 1-2 weeks post-discharge. Electronic record data obtained 30 days post-discharge.
Setting: 562-bed tertiary-care academic medical center.
Patients: Consecutive sample of patients who underwent LA or LC between September 2017-February 2019 (n=75).
Interventions: 10-minute telephone survey including questions on the amount of opioid prescribed and used after surgery. Opioid prescription details were obtained from retrospective chart review with patient permission.
Main Outcome Measures: Opioid prescribed and used in morphine milligram equivalents (MME), proportion of opioid used.
Results: 12% (5/43) LA and 19% (6/32) LC patients did not receive a prescription at discharge. See Table 1 for medians and interquartile ranges (IQR) of MME prescribed and proportion used. Among patients prescribed opioids, 37% (14/38) LA and 27% (7/26) of LC patients used 0% of their prescription. Despite overall low usage, a bimodal distribution was observed, with 16% of LA and 22% of LC patients using 100-100%+ of their prescribed opioids (see Figure).

Table. MME prescribed and proportion used after laparoscopic appendectomy and cholecystectomy
LA (n=43)LC (n=32)
MME prescribed (IQR)68 (40-80)64 (39-80)
MME % used (IQR)20 (0-100)42 (0-100)

Conclusions: About 70% of patients use none to <50% of their opioid prescription after discharge from LA and LC. However about 20% of patients use more than their counterparts. Further research is needed to characterize patient and procedure factors contributing to this higher opioid use.

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