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The number of opioid pills prescribed after surgery was the strongest predictor of how many patients actually used, outweighing pain scores and other factors in a retrospective multicenter study.

On average, general surgery patients used 27% of the opioids they were prescribed -- but for every 10 extra pills prescribed, they used 5, reported Joceline Vu, MD, of the University of Michigan in Ann Arbor, and colleagues, in JAMA Surgery.

"It's like ordering a large plate for dinner: you're probably going to eat more than if you had a small plate," Vu told 麻豆传媒.

"Overall, we are prescribing much, much more than patients are consuming," she added. "As surgeons, we often don't know how much of a prescription a patient uses. Unlike a prescription for back pain, we don't say, 'Take three of these per day.' We say, 'Here's 30 pills; take them if you need them.' We know people don't take all of those pills. We know some stick around in patients' medicine cabinets."

The researchers looked at data from 2,392 patients who had one of 12 surgical procedures in 2017 at 33 Michigan hospitals that belonged to the (MSQC). Patients were an average age of 55 years old and 57% were women; they completed telephone or mail surveys 30 to 120 days after surgery.

The most common procedures were open and laparoscopic inguinal/femoral hernia repair (28%), laparoscopic cholecystectomy (25%), and laparoscopic appendectomy (9%). No vascular procedures were included in the analysis due to small sample size. The MSQC collected data about general surgery, vascular surgery, and some gynecologic procedures, but orthopedic surgery, neurosurgery, thoracic surgery, and other procedures were not included, Vu noted.

Overall, the median amount of opioids prescribed was 150 oral morphine equivalents (OME), equal to 30 pills of hydrocodone/acetaminophen, 5/325 mg. The median amount of opioids patients reported using was 45 OME or 9 pills (P<0.001).

For each additional OME prescribed, patients used an additional 0.53 OME (95% CI 0.40-0.65; P<0.001). Quantity of opioids prescribed had the strongest association with opioid use (standardized beta 0.565). Higher pain scores in the week after surgery also were linked with increased opioid use, but to a lesser degree (standardized beta 0.184 for moderate pain; 0.217 for severe pain).

Compared with patients reporting no pain, patients who reported moderate pain used an average of 9 more pills and patients who reported severe pain used 16 more pills (P<0.001). Tobacco use, American Society of Anesthesiologists class, age, procedure type, and inpatient surgery status also were tied to higher use.

"As surgeons, we want to align our prescribing with patient needs in order to provide the best care while minimizing the risk of opioid diversion and downstream misuse," said Gabriel Brat, MD, of Beth Israel Deaconess Medical Center in Boston, who was not involved with the research.

"This study of general surgery and gynecology patients is an important addition to the national effort to collect and use patient level opioid consumption data for that purpose," Brat told 麻豆传媒. "We need this type of work to help quantify where overprescribing is prevalent across all surgeries and identify personalized levers for change."

The research has several limitations, noted Vu and co-authors. Because it is based on observational data, it does not show causality. Pre-operative opioid use data was not available and may have affected outcomes. Patients' recollection of how many pills they used also may not be accurate.

The analysis was completed before a was enacted this year that prohibits physicians from prescribing more than a 7-day supply of opioids for acute pain patients.

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