The single greatest predictor of the amount of opioid used after surgical discharge is the amount of postoperative opioid prescribed.

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• Ryan Howard, Brian Fry, Vidhya Gunaseelan, Jay Lee, Jennifer Waljee, Chad Brummett, Darrell Campbell, Elizabeth Seese, Michael Englesbe, and Joceline Vu.
• Department of Surgery, University of Michigan, Ann Arbor.
• JAMA Surg. 2019 Jan 1; 154 (1): e184234.

ImportanceThere is growing evidence that opioids are overprescribed following surgery. Improving prescribing requires understanding factors associated with opioid consumption.ObjectiveTo describe opioid prescribing and consumption for a variety of surgical procedures and determine factors associated with opioid consumption after surgery.Design, Setting, And ParticipantsA retrospective, population-based analysis of the quantity of opioids prescribed and patient-reported opioid consumption across 33 health systems in Michigan, using a sample of adults 18 years and older undergoing surgery. Patients were included if they were prescribed an opioid after surgery. Surgical procedures took place between January 1, 2017, and September 30, 2017, and were included if they were performed in at least 25 patients.ExposuresOpioid prescription size in the initial postoperative prescription.Main Outcomes And MeasuresPatient-reported opioid consumption in oral morphine equivalents. Linear regression analysis was used to calculate risk-adjusted opioid consumption with robust standard errors.ResultsIn this study, 2392 patients (mean age, 55 years; 1353 women [57%]) underwent 1 of 12 surgical procedures. Overall, the quantity of opioid prescribed was significantly higher than patient-reported opioid consumption (median, 30 pills; IQR, 27-45 pills of hydrocodone/acetaminophen, 5/325 mg, vs 9 pills; IQR, 1-25 pills; P < .001). The quantity of opioid prescribed had the strongest association with patient-reported opioid consumption, with patients using 0.53 more pills (95% CI, 0.40-0.65; P < .001) for every additional pill prescribed. Patient-reported pain in the week after surgery was also significantly associated with consumption but not as strongly as prescription size. Compared with patients reporting no pain, patients used a mean (SD) 9 (1) more pills if they reported moderate pain and 16 (2) more pills if they reported severe pain (P < .001). Other significant risk factors included history of tobacco use, American Society of Anesthesiologists class, age, procedure type, and inpatient surgery status. After adjusting for these risk factors, patients in the lowest quintile of opioid prescribing had significantly lower mean (SD) opioid consumption compared with those in the highest quintile (5 [2] pills vs 37 [3] pills; P < .001).Conclusions And RelevanceThe quantity of opioid prescribed is associated with higher patient-reported opioid consumption. Using patient-reported opioid consumption to develop better prescribing practices is an important step in combating the opioid epidemic.

This article appears in the collection: Anesthesia & Perioperative Contribution to the Opioid Epidemic.

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