Postoperative Pain Management in the US vs Low-and-Middle-Income Countries by US Surgeons

Despite an ongoing opioid epidemic in the United States, opioids remain overprescribed after surgery compared to the rest of the world. How US surgeons prescribe pain medications on short-term surgical trips while operating in other countries is not understood. This study compared opioids prescribed after surgery in the United States versus during short-term surgical trips to Ghana, Peru, and Sierra Leone by surgeons from one academic institution.

Chart review was completed for adult patients undergoing open inguinal hernia repair between 2013 and 2019. Charts were reviewed for demographic and perioperative characteristics, opioid and non-opioid pain medication prescriptions within 24 hours of surgery, and opioid prescriptions on discharge, which were then compared between US and low-and-middle-income country (LMIC) patients from Peru, Ghana, and Sierra Leone.

In total 558 patients met inclusion criteria. The median age was 52 years; 89.2% of patients were male, and 30.6% had prior opioid exposure. After surgery, 76.0% of US patients received opioids versus 19.4% of LMIC patients combined (p<0.00001). US patients undergoing hernia repair received a median of 8.7 mg oral morphine equivalents (OMEs) (IQR 15 mg), while LMIC patients received a median of 0 mg OMEs (IQR 0 mg; p<0.0001).

Surgeons practicing in the US prescribe significantly higher amounts of opioid medications postoperatively compared to when operating on short-term surgical trips to other countries. Despite efforts to reduce opioid overprescription in the US, there is still room for improvement in encouraging reduced opioid use and increased reliance on non-opioid pain medications after surgery.