Variation in post-discharge opioid prescriptions among members of a surgical team

Blay, E., Jr.; Nooromid, M. J.; Bilimoria, K. Y.; Holl, J. L.; Lambert, B.; Johnson, J. K.; Stulberg, J. J.

Am J Surg. 2017 Nov 14; 216(1):25-30

Abstract

BACKGROUND: Surgeons play a pivotal role in the opioid epidemic but it is unknown how different members of a surgical team vary in the way they prescribe opioids after surgical episodes. STUDY DESIGN: We conducted a retrospective cohort study of all inpatient discharges for 5 common surgeries. Total number of tablets and total milligram equivalents (MME) prescribed were calculated and differences in prescription patterns were determined for attending surgeons, surgical residents and advanced practice providers. Using a generalized ordered logistic regression, we examined factors associated with ordering a higher number of tablets or MME. RESULTS: The median number of tablets (range) prescribed by rank were attending surgeon 30 (6-72), surgical resident 20 (6-189) and advanced care practitioner 40 (5-1000); p < 0.001.The median total MME prescribed by rank were attending surgeon 140 (30-600), surgical resident 200 (30-1600) and advanced practice provider 240 (25-1000); p < 0.001. There was no statistically significant difference by resident postgraduate year (PGY) for both total tablets and total MME prescribed. General surgery residents on average ordered a narrower range of total MME compared to surgical residents in other surgical specialties [20 (50-600) vs 20 (30-1600); p = 0.03]. On regression analysis, residents were less likely to order a higher number of tablets compared to attending surgeons (OR 0.29, p = 0.01). However, surgical residents and advanced care providers were more likely to prescribe a higher total MME compared to attending surgeons (OR 7.12, p < 0.001; OR 3.39, p = 0.01 for surgical resident and OR 6.46, p = 0.01) for advanced practice providers). CONCLUSION: There is wide variation in opioid prescription patterns by surgical providers. More studies are needed to clearly define the ideal number of tablets or MMEs to prescribe for common surgical procedures.

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