The optimal length of postoperative opioid prescriptions is four to nine days for general surgery procedures, four to 13 days for women's health procedures, and six to 15 days for musculoskeletal procedures, a study found.
Researchers used the Department of Defense Military Health System Data Repository to identify opioid-naive individuals 18 to 64 years of age who had undergone one of eight common surgical procedures between Jan. 1, 2005, and Sept. 30, 2014. They looked at length of initial prescription for opioid pain medication and the need for an additional prescription for opioid pain medication or a refill. Results were published online Sept. 27 by JAMA Surgery.
Of the 215,140 patients who received and filled at least one prescription for an opioid within 14 days of a procedure, 19.1% received at least one refill prescription. The median prescription lengths were four days (interquartile range [IQR], three to five days) for appendectomy and cholecystectomy, five days (IQR, three to six days) for inguinal hernia repair, four days (IQR, three to five days) for hysterectomy, five days (IQR, three to six days) for mastectomy, five days (IQR, four to eight days) for anterior cruciate ligament repair and rotator cuff repair, and seven days (IQR, five to 10 days) for discectomy.
The authors wrote that ideally opioid prescriptions after surgery should balance adequate pain management against the duration of treatment. “Although 7-day limits on initial opioid pain medication prescriptions are likely adequate in many settings, and indeed also sufficient for many common general surgery and gynecologic procedures, in the postoperative setting, particularly after many orthopedic and neurosurgical procedures, a 7-day limit may be inappropriately restrictive,” the authors wrote. “Critically, further work is needed to better identify the 10% to 30% of patients who will require more intensive pain management to better tailor postoperative pain regimens to these individuals.”
An editorial stated that surgeons should have patients anticipate some postoperative discomfort rather than expect a pain-free recovery and should discuss other analgesics to try before opioids, with an option to escalate to them if needed.
“In this population of more than 200,000 people, the authors found a marked variation in the timing and frequency of requests for narcotic prescriptions among postoperative patients who had undergone various operations,” the editorial stated. “We hope the days of writing a prescription for 60 tablets of acetaminophen and oxycodone hydrochloride (Percocet) to discourage follow-up telephone calls for refills are gone. We are living in the midst of an ongoing crisis.”
Another, separate study found that patients who are prescribed opioids for the first time in the ED are less likely to become long-term users and more likely to receive prescriptions in accordance with CDC guidelines compared to other medical settings.
The analysis of 5.2 million prescriptions for opioids issued from the ED showed that the percentage of opioid prescriptions exceeding seven days was 84% to 91% lower (depending on insurance status) than in nonemergency settings. Prescriptions from the ED were 23% to 37% less likely to exceed 50 mg of morphine equivalents and 33% to 54% less likely to exceed 90 mg of morphine equivalents (a high dose). Prescriptions from the ED were 86% to 92% less likely to be written for long-acting or extended-release formulations than those attributed to nonemergency settings. The study was published by Annals of Emergency Medicine on Sept. 26.