Many Opioid Prescriptions After Surgery Are Unnecessary, Study Finds

New research has found that patients who received non-opioid pain medications following surgery had effective pain control with equivalent short-term outcomes and patient satisfaction, according to a press release from Michigan Medicine.

Treating postsurgical pain with medications such as ibuprofen or acetaminophen did not result in higher pain levels or more serious issues during recovery and did not lower patients’ satisfaction with their care, according to the results from a study of more than 22,000 patients who had 1 of 7 common operations at 70 hospitals.

Investigators analyzed 2019 data from a Michigan-wide surgical care registry, then surveyed patients about their experience after they had recovered. The results, published in Annals of Surgery, showed similar outcomes and experiences with and without opioids.

Specifically, 86% of the patients received a prescription for an opioid after they had hernia, gallbladder, appendix, bowel, thyroid, or gynecological operations. However, when the researchers compared those patients’ experiences and survey responses with data from the 14% of patients who received non-opioid painkiller prescriptions, they found very little difference.

An equal percentage (12%) of each group had a major adverse event within 30 days of their initial operation. There was no difference in complications, emergency department visits, or reoperations between the groups, and patients not prescribed opioids were slightly more likely to be readmitted to the hospital. The investigators noted, however, that these readmittances were rarely due to pain-related issues, according to the press release. There was also no difference in the percentage who sought emergency care for pain.

The survey was carried out between 1 and 3 months after their operation and asked patients about their pain levels in the first 7 days after they left the hospital, their satisfaction with their care, their quality of life, and their level of regret about having surgery. Nearly 60% of patients completed the survey.

Among both groups, 82% of respondents said they were highly satisfied with their care. Furthermore, 93% of both groups said they had no regret about their surgery.

Patients who received non-opioid prescriptions were actually more likely to report having no pain in the first week after surgery than those who received opioids (12% and 7%, respectively). The non-opioid patients were also more likely to say that they had the best possible quality of life after surgery (66% and 63%, respectively).

“Opioids have been a routine part of post-surgical pain care for decades, but the risk that they could lead to persistent use has been clearly documented,” said lead author Ryan Howard, MD, a surgical resident at Michigan Medicine, in the press release. “Perhaps it’s time to make them the exception, not the rule.”

The investigators noted that 16% of patients in the study were taking opioids on an ongoing basis prior to their operations. Importantly, long-term opioid use is known to increase risks from surgery, according to the study.

“This study clearly shows no difference in pain, major adverse events, or patient-centered outcomes when opioids aren’t prescribed,” said senior author Mark Bicket, MD, PhD, a co-director of the Michigan Opioid Prescribing Engagement Network, in the press release. “The growing body of evidence about the risk of opioid medications to the patient, and to others who might misuse leftover pills from the patient’s prescriptions, has to be considered together with evidence about their relative effectiveness for pain control.”

A second new study used national insurance claims data to document new persistent opioid use and the costs of care for surgical patients who had not been taking opioids before their operations. These findings, also from Michigan Medicine, were published in the Journal of Managed Care and Specialty Pharmacy.

The investigators found that between 4% and 7% of all patients who had surgery that required a hospital stay went on to fill opioid prescriptions months after their pain should have subsided. The authors defined this trend as persistent opioid use. The same was true for between 1.5% and 6.4% of patients who had an outpatient operation. None of the patients in this study had been filling opioid prescriptions before their surgery.

Patients with persistent opioid use following surgery went on to have more hospital and emergency care in the year following their operation compared to patients who did not fill an opioid prescription immediately after their operation. Although some of the patients who did not fill an opioid prescription did receive opioids for other reasons later in the follow-up year, the researchers said those who started taking opioids after surgery received 5 times more opioid prescriptions and much higher overall health care costs.

REFERENCE

Gavin K. Many surgery patients get opioid prescriptions, but many don’t need to, study suggests. Michigan Medicine Health Lab. June 11, 2021. Accessed June 22, 2021. https://labblog.uofmhealth.org/rounds/many-surgery-patients-get-opioid-prescriptions-but-many-dont-need-to-study-suggests