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Wide Variation and Over-Prescription of Opioids Following Elective Surgery
Cornelius A Thiels1, Stephanie S. Anderson1, Daniel S. Ubl1, Kristine T Hanson1, Whitney J Bergquist1, Richard J Gray2, Halena M Gazelka1, Robert R Cima1, Elizabeth B Habermann1
1Mayo Clinic, Rochester, MN;2Mayo Clinic, Scottsdale, AZ

OBJECTIVE(S): In an effort to minimize the contribution of prescription narcotics to the nationwide opioid epidemic, postoperative opioid prescribing guidelines have been developed. Minnesota recommends a maximum of 200mg oral morphine equivalents (OME) for postoperative pain in opioid naïve patients. We aimed to identify opioid prescribing practices across specialties and institutions.
METHODS: Adults undergoing 25 common elective procedures 2013-2015 were identified from National Surgical Quality Improvement Program data from three academic centers in Minnesota, Arizona, and Florida. Opioids prescribed at discharge were abstracted from pharmacy data and converted into OME. Wilcoxon Rank-Sum and Kruskal-Wallis tests assessed variations.
RESULTS: Of 7651 patients, 94.3% received opioid prescriptions at discharge. Of 7217 patients who received opioid prescriptions, a median of 450 OME (IQR 225-850) were prescribed. Median OME varied by sex (420 male vs 450 female, p=0.005) and increased with age (395 age 18-39 to 525 age 80+, p<0.001). Obese patients and patients with non-cancer diagnoses received more opioids (both p<0.001). No difference was seen across race, between readmitted patients, or those who experienced complications (all p>0.05). Subset analysis of the 5756 (75.2%) opioid naïve patients showed the majority received >200 OME (81.5%), which varied across procedures (Figure).
CONCLUSIONS: The majority of patients were over-prescribed opioids. Significant prescribing variation exists that was not explained by patient factors. These data will guide practices to optimize opioid prescribing after surgery.

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