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    Mayo Clinic Study Investigates Opioid Use after Surgery

    Nearly a third of patients responding to Mayo Clinic survey said they used none of the opioids they were prescribed after surgery, and only about 8% of patients disposed of their remaining opioids.

    The research findings were presented at the annual meeting of the American Surgical Association.

    The researchers also found that:

    • At discharge, 92% of patients received an opioid prescription.
    • Of the opioids prescribed, 63% went unused.
    • Ninety percent of patients were satisfied with their pain control.
    • Twenty-eight percent said they were prescribed too many opioids, while 8% said they were prescribed too few.
    • The median amount of opioids consumed per patient equaled about 6 5-mg oxycodone tablets.

    To conduct the research, a cross-specialty team of physicians and researchers surveyed 1907 patients who underwent 25 common surgeries – including total hip and total knee arthroplasty and rotator cuff repair – at 3 academic medical centers. The amount of opioids patients took after discharge depended on the type of surgery.

    “This research provides a road map for physicians and surgical departments. It shows there are certain surgeries and types of patients who are likely receiving significantly more opioids than needed,” said senior author Elizabeth Habermann, PhD, the Robert D. and Patricia E. Kearn Scientific Director for Surgical Outcomes at Mayo Clinic in Rochester, Minnesota.

    In addition, the findings identify factors that can help develop guidelines and optimize opioid prescriptions patients receive after surgery. Mayo Clinic has implemented evidence-based opioid prescribing guidelines specific to surgical areas, beginning with the Department of Orthopedic Surgery, based on this research and the team’s previous findings. These guidelines already have led to a considerable reduction in opioid prescriptions. As one example, the median amount prescribed dropped by half for total knee and total hip arthroplasty.

    “These new Mayo Clinic guidelines allow prescribers to tailor their prescribing to address the needs of patients who need very little or no opioids, along with those who need more pain control, while still optimizing and reducing prescribing across the board,” said lead author Cornelius Thiels, DO, a general surgery resident in the Mayo Clinic School of Graduate Medical Education.

    Patient factors associated with a lower use of opioids include:

    • Older age
    • No history of anxiety
    • Lower pain score at discharge

    Factors that could potentially predict the need for more opioids include:

    • Younger age
    • History of anxiety
    • Higher pain score at discharge

    “Opioid prescribing guidelines should be based on evidence, considering patient factors and the type of procedure, but also allowing for prescriber discretion,” Dr. Habermann said. “This research and numerous other opioid prescribing projects at Mayo Clinic are about identifying the best approach for each individual patient, whether that’s increasing, decreasing or maintaining prescription levels.”

    The researchers also suggest that the current one-size-fits-all maximums for opioid prescribing that are being advocated by many prescription drug plans and legislators to treat acute pain may not be in the best interest of patients.

    “They are not patient-centered and may inadvertently encourage both over- and underprescribing,” Dr. Thiels said. “This highlights to us the importance of developing procedure-specific, evidence-based discharge opioid prescribing guidelines.”

    The researchers add that when patients do not dispose of their excess opioids, more of the drugs are available for potential use by others who did not receive the prescription, contributing to the opioid issues facing the US. They say reducing prescriptions, when appropriate, and educating communities on proper disposal will reduce that risk.

    Opioid prescription totals in the US, while decreasing from 2011 to 2015, were still 3 times higher in 2015 than in 1999, according to the newest data from the Centers for Disease Control and Prevention (CDC). Between 1999 and 2016, the number of opioid overdose deaths increased fivefold, the CDC said.

    Source

    Thiels CA, Uble DS, Yost KJ, et al. Significant Numbers of Patients Require No Opioids After Discharge: Results of a Prospective Multicenter Initiative Aimed at Developing Opioid Prescribing Guidelines for 25 Elective Surgeries. Presented at the 138th Annual Meeting of the American Surgical Association, April 19-21, 2018, Phoenix, Arizona.