Evidence-based opioid prescribing guidelines after lung resection: a prospective, multicenter analysis.

Area of Science:

• Thoracic Surgery
• Oncology
• Pain Management

Background:

• Opioid prescribing guidelines have reduced overuse in cardiac surgery.
• Limited recommendations exist for general thoracic surgery, a high-risk group.
• Lung cancer resection patients require tailored opioid guidelines.

Purpose of the Study:

• To develop evidence-based opioid prescribing guidelines for lung cancer resection.
• To examine opioid prescribing patterns and patient-reported use post-discharge.

Main Methods:

• Prospective, statewide quality improvement study (Jan 2020-Mar 2021).
• Included 429 patients undergoing primary lung cancer resection across 11 institutions.
• Linked patient-reported outcomes with clinical and STS database records.

Main Results:

• 83.4% received opioid prescriptions (mean 20.5 pills), but patients used only 8.2 pills post-discharge (43.7% used none).
• Patients not on opioids pre-discharge used significantly fewer pills (4.4 vs. 11.7).
• Pain scores were low (2.4 incision, 3.0 overall).

Conclusions:

• Patient-reported post-discharge opioid use is key for guideline development.
• Surgical approach and in-hospital use should inform prescribing.
• Personalized opioid prescribing is recommended after lung resection.