Scully RE, et al. - Researchers carried out this study to elucidate patterns of opioid pain medication prescriptions after common surgical procedures and assess the appropriateness of the prescription as indicated by the rate of refills. As per observations, ideal opioid prescriptions after surgery should support adequate pain management against the duration of treatment. The optimal length of opioid prescriptions in practice lies between the observed median prescription length and the early nadir, or 4 to 9 days for general surgery procedures, 4 to 13 days for women’s health procedures, and 6 to 15 days for musculoskeletal procedures.

Methods

• Opioid-naive individuals 18 to 64 years of age who had undergone 1 of 8 common surgical procedures were identified from the Department of Defense Military Health System Data Repository from January 1, 2005, to September 30, 2014.
• Using a generalized additive model with spline smoothing, researchers modeled the adjusted risk of refilling an opioid prescription based on the number of days of initial prescription.
• They assessed the need for an additional subsequent prescription for opioid pain or a refill.

Results

• Within the study time frame, 215 140 individuals(107 588 women and 107 552 men; mean [SD] age, 40.1 [12.8] years) underwent a procedure and received and filled at least 1 prescription for opioid pain medication within 14 days of their index procedure; 41 107 (19.1%) received at least 1 refill prescription.
• In this work, the median length of initial prescription for opioid pain medication was 4 days (interquartile range [IQR], 3-5 days) for appendectomy and cholecystectomy, 5 days (IQR, 3-6 days) for inguinal hernia repair, 4 days (IQR, 3-5 days) for hysterectomy, 5 days (IQR, 3-6 days) for mastectomy, 5 days (IQR, 4-8 days) for anterior cruciate ligament repair and rotator cuff repair, and 7 days (IQR, 5-10 days) for discectomy.
• For general surgery procedures, the early nadir in the probability of refill was at an initial prescription of 9 days (probability of refill, 10.7%), for women’s health procedures, it was 13 days (probability of refill, 16.8%), and for musculoskeletal procedures, it was 15 days (probability of refill, 32.5%).