Opioid Prescriptions After Hemorrhoidectomy.

Area of Science:

• Colorectal Surgery
• Pain Management
• Public Health

Background:

• Hemorrhoidectomy is associated with significant postoperative pain, leading to over 4 million US ambulatory care visits annually.
• Current evidence-based guidelines for opioid prescribing in hemorrhoidectomy patients are lacking.
• Opioid use and refill patterns post-hemorrhoidectomy are not well-defined.

Purpose of the Study:

• To investigate opioid prescribing patterns following hemorrhoidectomy.
• To identify factors associated with opioid refill after this procedure.

Main Methods:

• Retrospective database review of the Military Health System Data Repository (2006-2014).
• Included opioid-naïve patients aged 18-64 undergoing surgical hemorrhoidectomy with TRICARE insurance.
• Measured opioid prescription patterns and predictors of a second prescription within two weeks of the initial prescription's end date.

Main Results:

• 6294 patients were analyzed; 88% received an initial opioid prescription (median 5-day supply), and 32.9% required a refill.
• Initial prescription supply duration influenced refill risk, with a 10-day supply showing a 26.1% refill risk compared to 39.2% for a 1-day supply.
• Factors associated with refill included black race (OR=0.75), history of substance abuse (OR=3.26), and longer initial prescription durations (4-6 days or ≥7 days).

Conclusions:

• Significant variability exists in prescription opioid duration post-hemorrhoidectomy.
• Approximately one-third of patients require opioid refills in the immediate postoperative period.
• A 5- to 10-day opioid supply may be optimal for balancing adequate analgesia and minimizing excess medication.