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For common surgical procedures, 7 days usually sufficed for opioid-naive patients, but duration depended on the type of procedure performed. Surgeons vary considerably in the dose and duration of opioids they prescribe to patients postoperatively. To better define optimal postoperative opioid prescribing, researchers used a U.S. Department of Defense Military Health System database to identify opioid-naive patients (age range, 18–64) who had undergone one of eight common surgical procedures between 2005 and 2014. More than 215,000 patients filled at least one prescription for opioids within 14 days of their procedures, and 19% received at least one refill. Although 7-day durations sufficed for most patients, significant variability in duration of opioid consumption was noted among types of procedures: Patients who underwent musculoskeletal procedures (e.g., anterior cruciate ligament repair, discectomy) generally required longer duration and more frequent refills than those who underwent women’s health procedures (e.g., mastectomy, hysterectomy) or general surgery procedures (e.g., appendectomy, cholecystectomy). |
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COMMENT
A 7-day limit on initial opioid prescription might be adequate for many common general surgery and gynecologic procedures, but for patients undergoing orthopedic interventions, such a limit might be inappropriately restrictive. This study did not include amount of daily morphine milligram equivalents (MMEs) prescribed or consumed or patients’ expected goals for pain control (tolerable vs. “pain free”). However, these findings reinforce that the degree and duration of acute pain depends on several factors, including type of surgery. As we strive to curb opioid prescribing, studies like this are vital to developing safe and effective evidence-based postsurgical pain-management recommendations.