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Area of Science:

  • Pharmacology and Health Services Research
  • Surgical Outcomes and Pain Management

Background:

  • Post-appendectomy opioid prescribing varies significantly across healthcare systems.
  • Existing guidelines advocate for conservative opioid use and non-opioid alternatives.
  • Prescribing patterns and refill probabilities post-appendectomy in the U.S. Military Health System (MHS) were previously uncharacterized.

Purpose of the Study:

  • To analyze opioid prescribing practices following appendectomies within the MHS.
  • To identify factors influencing morphine equivalent dose (MED) at discharge and 30-day opioid refill probability.
  • To assess the impact of the Defense Health Agency (DHA) opioid safety policy on prescribing.

Main Methods:

  • Retrospective observational cohort study of 11,713 appendectomy patients (January 2016 - June 2021).
  • Utilized linear-mixed and generalized linear-mixed models to evaluate patient, care, and system-level factors.
  • Primary outcomes: MED at discharge and probability of 30-day opioid prescription refill; sensitivity analyses performed.

Main Results:

  • Discharge MED averaged twice the recommended guidance and was not linked to refill likelihood.
  • Higher discharge MED associated with opioid/non-opioid combinations, lack of non-opioid use, pre-DHA policy care, nicotine dependence, and prior opioid use.
  • Opioid refill more probable with complicated appendicitis, female sex, mental health diagnoses, antidepressant use, and nicotine dependence; less likely after DHA policy implementation and for opioid-naïve patients.

Conclusions:

  • While individual prescribing adjusted to new guidelines, unwarranted variation in opioid dose persisted.
  • Factors beyond clinical need appear to influence prescribing and refill behaviors.
  • Future research should focus on patient experience, satisfaction, and education to standardize care and optimize pain management.