Procedure Determines How Long Post-Surgical Patients Should Receive Opioids

Study Uses MHS Data to Create Guidelines for Painkillers

BOSTON – How long should patients use opioids after common surgical procedures?

Until now, there hasn’t been much consensus on the answer. A new study analyzing prescription data from the DoD’s Military Health System Data Repository recently sought to remedy that, however.

A study team led by researchers at the Center for Surgery and Public Health at Brigham and Women’s Hospital in Boston and including participation from the Uniformed Services University of the Health Sciences in Bethesda, MD, pointed out that few guidelines detail the optimal way to prescribe postsurgical painkillers, balancing pain control without increasing the risk of addiction.

The goal was to examine whether prescriptions were appropriate—looking at the rate of refills as one indicator—and to develop recommendations.

To do that, the researchers focused on slightly more than 200,000 MHS patients who had no recent history of opioid use. Nationally, representative subjects in the study, which was published in JAMA Surgery, had undergone one of eight common surgical procedures between 2006 and 2014 and were prescribed opioid medications to help control pain.1

Results indicated that median prescription length for first-time opioid prescriptions ranged from four to seven days, and, according to the type of procedure performed, the percentage of patients requiring refills could be anywhere from 11.3% to 39.3%.

Average duration of the prescription also was affected by the procedure category; that varied from nine days for general surgery procedures to 15 days for musculoskeletal procedures.

“While seven days may be more than adequate for many patients undergoing common general surgery and gynecological procedures, prescription length limits may need to be extended to 10 days, recognizing that as many as 40 percent of patients may still require a refill at a seven-day limit for pain management, particularly following many orthopedic and neurosurgical procedures,” explained Rebecca Scully, MD, MPH, a BWH surgical resident.

Data was derived from the Military Health System Data Repository, which tracks care delivered to active, disabled and retired members of the U.S armed forces and their dependents. Initially identified were 215,140 adult patients, average age 40.1, who had filled at least one postsurgical pain medication prescription within 14 days of surgery. They all had undergone one of eight common procedures:

  • cholecystectomy,
  • appendectomy,
  • inguinal hernia repair,
  • ACL reconstruction,
  • rotator cuff tear repair,
  • discectomy,
  • mastectomy or

Excluded from the study were those with a prior diagnosis of chronic pain, substance dependence or an opioid prescription within six months preceding the index procedure.

Most of the patients, more than 122,000, underwent general surgery. Another nearly 48,000 had musculoskeletal procedures and the remaining nearly 45,000 had a mastectomy or hysterectomy.

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Comments (1)

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  1. Lisa C. Murcko, MD says:

    I think the difficulty is not from the opioid naïve patient postop, but from those who have had several procedures and have been given pain medication prescriptions in the past, and continuing to have elective procedures.
    These patients require further study because they seem to be more likely to request additional medication.

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