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Opioid prescribing after surgery is often not patient-centered, leading to over or underprescribing. A new metric based on 24-hour predischarge opioid consumption (PDOC) could improve opioid discharge prescriptions.

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Area of Science:

  • Surgery
  • Pharmacology
  • Patient Safety

Background:

  • Procedure-based opioid guidelines have reduced prescribed amounts post-surgery.
  • Despite guidelines, many patients remain overprescribed opioids.
  • The 24-hour predischarge opioid consumption (PDOC) metric is a proposed solution for patient-centered prescribing.

Purpose of the Study:

  • To assess the correlation between inpatient opioid use and discharge prescriptions.
  • To evaluate the adequacy of current opioid discharge prescriptions.
  • To explore the utility of the 24-hour PDOC metric for guiding opioid prescribing.

Main Methods:

  • Retrospective study of 596 patients undergoing major abdominal surgery.
  • Assessed correlation between inpatient opioid use and discharge prescriptions (MMEs).
  • Evaluated prescription adequacy using constant use and linear taper models based on 24-hour PDOC.

Main Results:

  • Weak correlation (r=0.35) found between inpatient opioid use and discharge prescriptions.
  • 22.3% of patients with no pre-discharge opioid use received prescriptions.
  • 82% of high-use patients received prescriptions lasting <48 hours.
  • A theoretical 4x PDOC prescription could enable linear tapering for 97.6% of patients.

Conclusions:

  • Opioid prescribing at the institution is rarely patient-centered.
  • Current prescribing practices lead to both overprescribing and underprescribing.
  • The 24-hour PDOC metric shows promise for optimizing opioid discharge prescriptions.