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

Excessive opioid prescribing after colorectal surgery can lead to adverse events and contribute to the opioid crisis. Understanding international prescribing patterns is essential for guiding practice and future research. The Analgesia After Colorectal Surgery (ACORE) survey aimed to characterize international opioid prescribing practices after elective colorectal resection.

This international cross-sectional survey followed established methodological guidelines. Eligible participants were colorectal, gastrointestinal, and general surgeons, as well as surgery trainees. Recruitment followed snowball sampling via international surgical societies' mailing lists, social media, and personal networks. The primary outcome of interest was post-discharge opioid prescribing after open and MIS elective colorectal resection. Secondary outcomes included prescription quantity in morphine milligram equivalents (MMEs). Data were analyzed using descriptive statistics and logistic regression with Bayesian model averaging.

Among 817 participants, 88% were surgeons, 12% were trainees, 62% practiced in academic hospitals, and 67% had over 5 years in practice. Overall, 57% of the participants reported prescribing opioids at discharge (55% after open and 54% after minimally invasive procedures). Opioids were commonly prescribed by surgeons practicing in Australia and New Zealand (100%), Northern America (92%), Northern Europe (68%), and South-eastern Asia (71%). In contrast, they were less frequently prescribed in Eastern Europe (11%), Eastern Asia (22%), Latin America and the Caribbean (26%), Southern Europe (19%), and Northern Africa (0%). The median quantity of opioids prescribed at discharge varied widely (30-200 MMEs). In regression analysis accounting for surgeon and practice characteristics, region of practice was the only factor independently associated with opioid prescribing.

The extensive global variation in opioid prescribing underscores clinical equipoise and challenges the assumption that post-discharge opioids are universally necessary for patients undergoing colorectal resection.