Hill MV, et al. - Researchers sought to determine an appropriate opioid prescribing for patients who are discharged after a hospital admission for a surgical procedure. It was noticed that post-discharge opioid use was best predicted by usage the day before discharge for patients admitted after surgical procedures. A substantial decrease in opioid prescriptions and an effective treatment of patients' pain could be achieved with the use of the guideline described in this study.

Methods

• Inpatients discharged to home after bariatric, benign foregut, liver, pancreas, ventral hernia, and colon surgery were studied.
• Researchers excluded chronic opioid users or patients who had complications.
• In 90% of the remaining patients, they quantified home opioid usage by questionnaires and phone surveys.

Results

• An opioid was prescribed to 85% of patients; 38% of prescribed opioid pills were taken.
• The opioid needs of 88% of patients discharged on postoperative day (POD) 1 were satisfied with 15 opioid pills.
• Multivariate analysis suggested that for patients discharged after POD 1 the number of opioid pills used at home was associated with the number taken the day before discharge (p < 0.0001) and patient age (p = 0.006), but not the type of surgery.
• No opioids were taken the day before discharge by 41% of patients, 33% took 1 to 3, and 26% took more than 4 pills.
• Home opioid requirements in eighty-five percent of patients' could be satisfied using the following guideline: if no opioid pills are taken the day before discharge, no prescription is needed; if 1 to 3 opioid pills are taken the day before discharge, then a prescription for 15 opioid pills is given at discharge; and if 4 or more pills are taken the day before discharge, then a prescription for 30 opioid pills is given at discharge.
• If these guidelines were used, the number of opioid pills prescribed would decrease by 40%.