R. E. Scully1, W. Jiang1, A. Schoenfeld1, M. A. Chaudhary1, S. Lipsitz1, P. Learn2, T. Koehlmoos2, A. Haider1, L. L. Nguyen1 1Brigham And Women’s Hospital,Center For Surgery And Public Health,Boston, MA, USA 2Uniformed Services University Of The Health Sciences,Bethesda, MD, USA
Introduction: Over-prescription of pain medications has been implicated as a driver of the burgeoning opiate epidemic. Accordingly, legislation limiting length of initial opioid prescription, typically to less than 7 days, has been recently passed in several states. The goal of the current project was to describe opioid pain medication prescription patterns following common surgical procedures and to determine the appropriateness of the prescription as indicated by the rate of prescription refills.
Methods: The Department of Defense Military Health System Data Repository (MDR) tracks care delivered to active, disabled, and retired members of the US armed forces and their dependents insured through TRICARE. The MDR was queried for individuals (age 18-64) who had undergone common surgical procedures between 2006 and 2014. Procedures chosen were cholecystectomy, appendectomy, hernia repair, anterior cruciate ligament reconstruction, rotator cuff tear repair, discectomy, mastectomy, and hysterectomy. Individuals with a prior diagnosis of chronic pain, substance dependence, or an opioid prescription within the 6 months preceding the index procedure were excluded. Refill was defined as repeat opioid prescription within 14 days of the end of the initial prescription. Adjusted risk of opioid prescription refill by number of days of initial prescription was modeled using a generalized additive model with spline smoothing.
Results: Among the 203,834 individuals included, the median length of initial opioid prescription was 4 days [Interquartile Range (IQR): 3-5 days] for general surgery procedures, 4 days [IQR 3-5 days] for women’s health procedures, and 6 days [IQR 5-9 days] for musculoskeletal procedures. When adjusted for clinical and demographic factors, the proportion of individuals requiring refill was low, regardless of length of initial prescription and type of procedure (Figure 1). The early nadir in probability of refill was at an initial prescription of 11 days for general surgery procedures (probability of refill = 7.87%), 14 days for women’s health procedures (probability of refill = 11.55%), and 19 days for musculoskeletal procedures (probability of refill = 1.36%).
Conclusions: An opiate prescription after surgery aims to balance adequate pain treatment while minimizing the duration of treatment. The statistically-modeled optimal initial prescription length appears to be somewhat longer than 7 days for the surgical procedures included here. In practice, the optimal length of opiate prescription lies between the observed median prescription length and the early nadir, or 4 to 11 days for general surgery procedures, 4 to 14 days for women’s health procedures, and 6 to 19 days for musculoskeletal procedures.
