Evaluating variation in opioid prescribing for emergency general surgery patients

Area of Science:

• Surgery
• Pharmacology
• Health Services Research

Background:

• Established guidelines exist for postoperative opioid prescribing in elective surgery.
• Adherence to these guidelines in the emergency general surgery setting is not well understood.
• Variations in emergency opioid prescribing may indicate deviations from best practices or necessary adaptations.

Purpose of the Study:

• To assess adherence to elective opioid prescribing guidelines for emergency general surgery.
• To evaluate variations in opioid prescribing practices across different facilities.
• To identify patient-level factors associated with non-guideline-concordant opioid prescriptions.

Main Methods:

• Analysis of data from a statewide Acute Care Surgery collaborative.
• Inclusion of patients undergoing laparoscopic appendectomy, cholecystectomy, emergency hernia repair, and open colectomy.
• Use of risk- and reliability-adjusted multilevel models to evaluate prescription size and guideline adherence.

Main Results:

• Significant facility-level variation in opioid prescribing (1.5-3.7-fold for morphine equivalents, 1.1-2.3-fold for opioid-free discharge).
• Colectomy prescriptions were notably less likely to be guideline concordant (25%) compared to appendectomy (4%).
• Increased comorbidity burden and higher ASA physical status were linked to non-guideline-concordant prescriptions.

Conclusions:

• Opioid prescribing patterns in emergency general surgery demonstrate considerable variability.
• Prescriptions frequently do not align with established guidelines for elective procedures.
• Procedure- and patient-specific factors in the emergency setting require consideration for optimizing opioid stewardship.