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

Area of Science:

• Global Surgery
• Pain Management
• Public Health

Background:

• Opioid overprescription persists in the US despite the ongoing opioid epidemic.
• Prescribing patterns of US surgeons during international short-term surgical trips are not well understood.
• This study compares postoperative opioid prescribing by US surgeons in the US versus during surgical trips to low- and middle-income countries (LMICs).

Purpose of the Study:

• To compare postoperative opioid prescribing practices between US and LMIC patients.
• To identify disparities in pain medication management.
• To inform strategies for reducing opioid overreliance in surgical care.

Main Methods:

• Retrospective chart review of adult patients undergoing open inguinal hernia repair (2013-2019).
• Comparison of opioid and non-opioid pain medication prescriptions within 24 hours of surgery and at discharge.
• Analysis of demographic and perioperative characteristics.

Main Results:

• 76.0% of US patients received opioids postoperatively, compared to 19.4% of LMIC patients (p<0.00001).
• US patients received a median of 8.7 mg oral morphine equivalents (OMEs), while LMIC patients received 0 mg OMEs (p<0.0001).
• A significant difference in opioid prescribing was observed between the US and LMICs.

Conclusions:

• US surgeons prescribe substantially higher quantities of opioids postoperatively than when operating in LMICs.
• There is significant potential to reduce opioid prescribing in the US surgical settings.
• Increased utilization of non-opioid pain medications should be encouraged to combat opioid overprescription.