Opioid stewardship after emergency laparoscopic general surgery

Area of Science:

• General Surgery
• Pain Management
• Public Health

Background:

• Postoperative opioid use contributes to the opioid crisis.
• Evidence-based practices are crucial for optimizing acute pain management.
• Characterizing current opioid practices can identify areas for improvement.

Purpose of the Study:

• To characterize opioid administration and prescribing practices after emergency laparoscopic general surgery.
• To identify areas for improvement in postoperative pain management.
• To reduce community opioid load.

Main Methods:

• Retrospective chart review of 200 opioid-naïve adult patients undergoing emergency laparoscopic appendectomies and cholecystectomies.
• Analysis of in-hospital opioid administration and discharge prescriptions, converted to oral morphine equivalents (OME).
• Comparison of practices with published literature and local guidelines.

Main Results:

• 69% of patients received in-hospital opioid analgesia (avg. 26.7 OME/day).
• 99.5% received discharge prescriptions (avg. 61.7 OME/day), exceeding in-hospital needs and guidelines.
• Discharge opioid doses were not correlated with in-hospital requirements; combination prescriptions (e.g., Percocet) were higher.

Conclusions:

• In-hospital opioid use generally aligns with guidelines.
• Discharge opioid prescriptions frequently exceed guidelines and patient needs.
• Prescribing practices require optimization to mitigate opioid crisis contribution.