Opioid prescriptions: are they really necessary after major intra-abdominal surgery? A single-centered prospective...

In an effort to curb opioid use, we instituted a no routine opioids protocol for major colorectal and general surgical procedures requiring inpatient admission.

This was a prospective cohort study with preintervention (control) and postintervention groups that included abdominal and pelvic surgery requiring inpatient admission. The control groups received opioid prescriptions at discharge in keeping with the surgeon's standard practice whereas the intervention group received counseling on the use of nonopioid analgesics and avoiding opioid use. The goal of the intervention was to stop prescribing routine opioids at discharge; all providers were instructed regarding this goal. State-level prescriptions were evaluated for receipt of opioids.

Of the 333 patients included in the study, 46% (89 of 192) in the control and 17% (24 of 141) in the intervention group received opioids within 30 days of discharge (P <.001). Although inpatient opioid usage was equivalent in both groups, the median morphine milligram equivalent prescription at discharge was 10 (IQR, 0-50) for the control group and 0 (IQR, 0-0) for the intervention group (P <.001). Thirty-day readmission rates were not significantly different between groups (P =.475).

For patients undergoing major intra-abdominal and pelvic surgery, opioid prescriptions can be safely omitted in opioid-naïve patients within the setting of a robust multidisciplinary enhanced recovery after surgery program, without compromising recovery.