Post-Discharge Opioid Prescribing After Elective Colorectal Resection: An International Survey

Area of Science:

• Surgical Oncology
• Pain Management
• Public Health

Background:

• Excessive opioid prescribing post-colorectal surgery contributes to adverse events and the opioid crisis.
• Understanding international prescribing patterns is crucial for clinical practice and research.
• The Analgesia After Colorectal Surgery (ACORE) survey investigated global opioid prescribing practices.

Purpose of the Study:

• To characterize international opioid prescribing practices after elective colorectal resection.
• To identify factors associated with post-discharge opioid prescribing.
• To assess variations in opioid prescription quantities.

Main Methods:

• An international cross-sectional survey of surgeons and trainees.
• Snowball sampling utilized international surgical societies, social media, and personal networks.
• Data analyzed using descriptive statistics and Bayesian model averaging.

Main Results:

• 57% of 817 participants prescribed opioids post-discharge (55% open, 54% minimally invasive).
• Prescribing rates varied widely by region, from 0% (North Africa) to 100% (Australia/New Zealand).
• Region of practice was the sole factor independently associated with opioid prescribing.

Conclusions:

• Significant global variation in opioid prescribing exists after colorectal surgery.
• Clinical equipoise regarding the necessity of post-discharge opioids is highlighted.
• Challenges the assumption of universal need for post-discharge opioids in this patient population.