Key result
Patients undergoing thoracic surgery were prescribed significantly more daily opioids at discharge (median 30 MME/day) than they used during hospitalization (median 15 MME/day, p < 0.001).
Why the study?
Does opioid prescribing at discharge exceed inpatient opioid use in patients undergoing thoracic surgery?
Observational (n=124)
No
Does opioid prescribing at discharge exceed inpatient opioid use in patients undergoing thoracic surgery?
Patients undergoing thoracic surgery are prescribed significantly more opioids at discharge than they require during their inpatient stay, highlighting a target for quality improvement to reduce excessive opioid dispensing.
Answers are grounded in this paper and cite their sources.
Discharge opioid prescriptions exceeded inpatient use after thoracic surgery; leaves open whether aligning them to actual needs curbs excess without worsening pain control.
The opioid crisis is a public health issue and has been linked to physician overprescribing. Pain management after thoracic surgery is not standardized at many centers, and we hypothesized that excessive narcotics were being dispensed on discharge. As a quality improvement initiative, we sought to understand current prescribing practices to better align the amount of opioids dispensed on discharge to actual patient needs. This was a single-center, retrospective review of patients undergoing thoracic surgery from 7/2015 to 7/2018. Demographics, operative data, perioperative pain medication use, and discharge pain medication prescriptions were analyzed. Opioids were converted to Morphine Milligram Equivalents (MME). Among 124 patients, 103 (83%) received intraoperative nerve blocks and 106 (85.5%) used PCAs. Prescribed MME/day at discharge were significantly higher than MME/day received during hospitalization (Median 30 [IQR 30-45] vs. 15 [IQR 5-24], p < 0.001) and were not associated with receiving a nerve block or PCA. By procedure, prescribed MME/day were significantly higher than inpatient MME/day for wedge resections (p < 0.001), segmentectomies (p = 0.02), lobectomies (p = 0.003), and thymectomies (p = 0.02). Patients are being discharged with significantly more opioids than they are using as inpatients. Education among prescribers and a standardized approach with patient-specific dosing may reduce excessive opioid dispensing.
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Pommerening et al. (2020) conducted an observational in Postoperative pain after thoracic surgery (n=124). Opioid prescribing at discharge vs. Inpatient opioid use was evaluated on Morphine Milligram Equivalents (MME) per day prescribed at discharge compared to MME per day used during hospitalization (p=<0.001). Patients undergoing thoracic surgery were prescribed significantly more daily opioids at discharge (median 30 MME/day) than they used during hospitalization (median 15 MME/day, p < 0.001).
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