Opioid-Prescribing Guidelines for Common Surgical Procedures: An Expert Panel Consensus - 24/08/18

Doi : 10.1016/j.jamcollsurg.2018.07.659

Heidi N. Overton, MD ^a, Marie N. Hanna, MD, MEHP ^b, William E. Bruhn, BS ^a, Susan Hutfless, PhD, MS ^c, Mark C. Bicket, MD ^b,^e, Martin A. Makary, MD, MPH, FACS ^a,^d,^⁎
for the
Opioids After Surgery Workgroup
Brian Matlaga, MD, MPH, Clark Johnson, MD, MPH, Jeanne Sheffield, MD, Ronen Shechter, MD, Hien Nguyen, MD, Greg Osgood, MD, Christi Walsh, CRNP, Richard Burkhart, MD, Alex Blair, MD, Wes Ludwig, MD, Suzanne Nesbit, PharmD, Peiqi Wang, MD, MPH, Suzette Morgan : Patient Representative, Christian Jones, MD, MS, Lisa Kodadek, MD, James Taylor, MD, MPH, Zachary Enumah, MD, Richard Gilmore, MD, Mehran Habibi, MD, MBA, Kayode Williams, MD, MBA, Jon Russell, MD, Karen Wang, MD, Joanna Etra, MD, Stephen Broderick, MD, Tiffany Zavadsky, RN

^a Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
^b Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
^c Department of Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD
^d Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
^e Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD

^∗Correspondence address: Martin A Makary, MD, MPH, FACS, Johns Hopkins University, Blalock 665, 600 N Wolfe St, Baltimore, MD 21287.Johns Hopkins UniversityBlalock 665, 600 N Wolfe StBaltimoreMD21287

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Friday 24 August 2018

Abstract

Background

One in 16 surgical patients prescribed opioids becomes a long-term user. Overprescribing opioids after surgery is common, and the lack of multidisciplinary procedure-specific guidelines contributes to the wide variation in opioid prescribing practices. We hypothesized that a single-institution, multidisciplinary expert panel can establish consensus on ideal opioid prescribing for select common surgical procedures.

Study Design

We used a 3-step modified Delphi method involving a multidisciplinary expert panel of 6 relevant stakeholder groups (surgeons, pain specialists, outpatient surgical nurse practitioners, surgical residents, patients, and pharmacists) to develop consensus ranges for outpatient opioid prescribing at the time of discharge after 20 common procedures in 8 surgical specialties. Prescribing guidelines were developed for opioid-naïve adult patients without chronic pain undergoing uncomplicated procedures. The number of opioid tablets was defined using oxycodone 5 mg oral equivalents.

Results

For all 20 surgical procedures reviewed, the minimum number of opioid tablets recommended by the panel was 0. Ibuprofen was recommended for all patients unless medically contraindicated. The maximum number of opioid tablets varied by procedure (median 12.5 tablets), with panel recommendations of 0 opioid tablets for 3 of 20 (15%) procedures, 1 to 15 opioid tablets for 11 of 20 (55%) procedures, and 16 to 20 tablets for 6 of 20 (30%) procedures. Overall, patients who had the procedures voted for lower opioid amounts than surgeons who performed them.

Conclusions

Procedure-specific prescribing recommendations may help provide guidance to clinicians who are currently overprescribing opioids after surgery. Multidisciplinary, patient-centered consensus guidelines for more procedures are feasible and may serve as a tool in combating the opioid crisis.

Le texte complet de cet article est disponible en PDF.

Plan

	Drs Overton and Hanna contributed equally to this work.
	Members of the Opioids After Surgery Workgroup who collaborated on this article are listed in Appendix 1.
	Disclosure Information: Nothing to disclose.
	Support: Dr Overton was supported in part by NIH 5T32CA126607-09. Dr Bicket received support from the Foundation for Anesthesia Education and Research.
	Disclaimer: The funders had no role in the design of the study, the expert panel process, or the approval of the finished manuscript.