Factors Contributing to Opioid Overprescribing at Surgical Discharge

Opioids remain the gold standard for treating acute pain, whereas overprescribing occurs regularly in the postoperative setting with little clinical guidance. The objective of this study is to examine whether the length of surgery is an independent risk factor for opioid overprescribing at discharge.

We conducted a retrospective case-control study to determine if there is an association between the length of surgery and overprescribed opioids. The setting was an academic medical center located in the southern region of the United States - an adult level-one trauma center. It is a general medical and surgical facility and a teaching hospital. The study was determined not to be human subject research by the local institutional review board.

Our final sample consisted of 4367 patients that met the eligibility criteria. Of these patients, 1347 (30.84%) had been discharged on morphine equivalent daily dose (MEDD) greater than the previously administered 24-h MEDD. After adjusting for other covariates, the logistic regression analysis of the length of surgery showed that the risk of opioid overprescribing increased as the surgery lasted longer (adjusted odds ratio [AOR] 1.150, 95% confidence interval [CI] 1.099-1.202) and showed that older patients (AOR 1.010, 95% CI 1.006-1.015), males (AOR 1.168, 95% CI 1.006-1.356), non-White individuals (AOR 1.192, 95% CI 1.029-1.380), and patients who experienced lower average pain scores (AOR 0.789, 95% CI 0.757-0.823) had a significantly higher risk of opioid overprescribing.

Overprescribing at discharge could result in unnecessary opioids in the community, which may, in turn, lead to opioid abuse, misuse, and diversion. Based on our study, opioid prescribing at discharge is often driven by factors other than inpatient opioid use. Therefore, considering patient-specific factors such as MEDD 24 h before discharge may be one of the most useful tools to help guide opioid prescribing.