Postoperative Opioid Consumption After Discharge: An Update From the Michigan Surgical Quality Collaborative...

Area of Science:

• Surgical quality improvement
• Pain management
• Public health

Background:

• Opioid analgesics are frequently prescribed for moderate-to-severe postoperative pain.
• Excessive opioid prescribing is linked to increased opioid utilization and potential misuse.
• Patient-reported data is crucial for refining opioid prescribing practices.

Purpose of the Study:

• To evaluate opioid consumption across 21 surgical procedures using the Michigan Surgical Quality Collaborative (MSQC) registry over four years.
• To update post-discharge opioid prescribing guidelines based on current patient consumption data.
• To compare patient-reported opioid consumption before and after guideline implementation.

Main Methods:

• Analysis of opioid-naive adult surgical patient data from the MSQC registry (January 2018 - October 2021).
• Primary outcome: patient-reported opioid consumption (oxycodone 5 mg equivalents).
• Guidelines updated based on the 75th percentile of consumption, referencing prior data (January 2018 - May 2019).

Main Results:

• 39,493 opioid-naive patients were included in the analysis.
• Guidelines remained unchanged for 7 common procedures; recommended ranges decreased for 9 procedures (most by 5 pills).
• New guidelines were established for 5 procedures, with all upper limits set at 10 pills or less.

Conclusions:

• Patient-reported opioid consumption generally decreased between 2018-2021 compared to 2018-2019.
• Updated guidelines were implemented for numerous procedures to optimize pain control and minimize prescribing harms.
• The study highlights the effectiveness of data-driven guideline updates in managing postoperative opioid use.