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
Cornelius A. Thiels*, Daniel S. Ubl*, Kathleen J. Yost*, Sean C. Dowdy*, Tad M. Mabry*, Halena M. Gazelka*, Robert R. Cima, Elizabeth B. Habermann*
Mayo Clinic, Rochester, MN
OBJECTIVE(S): To conduct a prospective, multicenter survey of patients regarding postoperative opioid use to inform evidence-based opioid prescribing guidelines.
METHODS: Adults (n=2550) undergoing 25 elective procedures were identified prospectively from three academic centers (4/2017-10/2017) to complete a 29-question telephone interview survey 21-35 days post-discharge (n=579 not contacted, n=64 refused). Discharge opioids were converted into Oral Morphine Equivalents (OME).
RESULTS: 1907 patients completed the survey, 92.2% received discharge opioids (median 225 [IQR 150,450] OME). A median of 44 [0,180] OME were consumed after discharge. On average, 62.7% of prescribed opioids were unused; 31.0% of patients used no opioids, and 52.3% required <50 OME. Refill rates ranged from 1.7% for laparoscopic inguinal hernia to 71.4% for lumbar fusion. Overall, 90.2% of patients were satisfied with their post-discharge pain control. 28.2% reported being prescribed too many opioids while 8.3% felt they were not prescribed enough. Only 7.5% of patients disposed of remaining opioids. Of the 1428 naïve patients (74.9% of surveyed patients), 33.5% consumed no opioids (range 0.0-75.0% by procedure; Figure) and 57.5% (66.6% of non-orthopedic) consumed <50 OME. Utilization data and predictors of low/high opioid consumption (Figure) will inform development of postoperative prescribing guidelines.
CONCLUSIONS: A large proportion of postoperative patients reported using no or few opioids following discharge. Guidelines should be further refined to minimize opioid prescribing and identify those patients requiring additional multi-modal pain control. 
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