Use of post-discharge opioid consumption patterns as a tool for evaluating opioid prescribing guidelines

Background: Leftover pills from postoperative opioid prescriptions place patients and members of their communities at risk for opioid misuse. We aimed to better understand patients' post-discharge opioid consumption patterns to inform new methods of postoperative opioid prescribing. Methods: We assessed post-discharge opioid consumption of general surgery patients and assessed the adequacy of discharge opioid prescriptions. We then compared patient opioid consumption to a number of theoretical discharge prescriptions based on different opioid prescribing guidelines and a proposed discharge prescription based on the metric 24-h pre-discharge opioid consumption (PDOC). Results: 62/99 patients (62.6%) returned an opioid log book. Median 24-h PDOC was 22.5 MME (IQR 5.0-45.0) and median discharge prescription size was 15 pills (IQR:10-20). Prescriptions were adequate for 83.7% of patients. The median number of pills used was 3 (IQR:0-11) and median time to opioid cessation was 3 days (IQR:0-5). Actual prescriptions were consistent with national opioid prescribing guidelines. Prescriptions based on the formula 2 x 24-h PDOC would have decreased the number of leftover pills by 7.5 per patient. Conclusions: Despite prescribing opioids consistent with national opioid prescribing guidelines, patients still receive too many pills. Improved opioid prescribing could be accomplished by use of the formula 2 x 24-h PDOC.

Automated summary

This study aimed to understand patients' postoperative opioid consumption patterns and evaluate the adequacy of discharge prescriptions. Despite adherence to national guidelines, patients received excessive opioid prescriptions. The formula 2 x 24-h PDOC was proposed to improve prescribing practices.