4.7 Article

Association of Postoperative Opioid Prescription Size and Patient Satisfaction

Journal

ANNALS OF SURGERY
Volume 276, Issue 6, Pages E1064-E1069

Publisher

LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/SLA.0000000000004784

Keywords

narcotics; opioids; patient-reported outcomes; patient satisfaction; prescription size; quality collaborative

Categories

Funding

  1. Blue Cross Blue Shield of Michigan Foundation
  2. Michigan Department of Health and Human Services
  3. National Institute on Drug Abuse [RO1 DA042859]

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In a large cohort of patients undergoing common surgical procedures, there was no significant association between opioid prescription size at discharge after surgery and patient satisfaction. This suggests that surgeons can provide smaller opioid prescriptions postoperatively without diminishing patient satisfaction.
Objective:To evaluate the association between postoperative opioid prescription size and patient-reported satisfaction among surgical patients. Summary background data:Opioids are overprescribed after surgery, which negatively impacts patient outcomes. The assumption that larger prescriptions increase patient satisfaction has been suggested as an important driver of excessive prescribing. Methods:This prospective cohort study evaluated opioid-naive adult patients undergoing laparoscopic cholecystectomy, laparoscopic appendectomy, and minor hernia repair between January 1 and May 31, 2018. The primary outcome was patient satisfaction, collected via a 30-day postoperative survey. Satisfaction was measured on a scale of 0 to 10 and dichotomized into highly satisfied (9-10) and not highly satisfied (0-8). The explanatory variable of interest was size of opioid prescription at discharge from surgery, converted into milligrams of oral morphine equivalents (OME). Hierarchical logistic regression was performed to evaluate the association between prescription size and satisfaction while adjusting for clinical covariates. Results:One thousand five hundred twenty patients met the inclusion criteria. Mean age was 53 years and 43% of patients were female. One thousand two hundred seventy-nine (84.1%) patients were highly satisfied and 241 (15.9%) were not highly satisfied. After multivariable adjustment, there was no significant association between opioid prescription size and satisfaction (OR 1.00, 95% CI 0.99-1.00). The predicted probability of being highly satisfied ranged from 83% for the smallest prescription (25 mg OME) to 85% for the largest prescription (750 mg OME). Conclusions:In a large cohort of patients undergoing common surgical procedures, there was no association between opioid prescription size at discharge after surgery and patient satisfaction. This implies that surgeons can provide significantly smaller opioid prescriptions after surgery without negatively affecting patient satisfaction.

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