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Opioid-free discharge after hepatopancreatobiliary surgery: Patterns, predictors, and opportunities for stewardship
Kaique Filardi1, Ashley Lanys2, Sara Saeidishahri1
1Department of Surgery, Hartford Hospital, Hartford, CT, USA.
Introduction:
Postoperative opioid prescriptions may represent an initial source of opioid exposure, yet discharge prescribing patterns after hepatopancreatobiliary (HPB) surgery remain poorly defined.
Methods:
We analyzed the 2024 ACS-NSQIP database to identify adults undergoing liver or pancreatic resection and evaluated opioid prescription at discharge, opioid-free discharge, and prescribed morphine milligram equivalents (MME) by procedure, operative approach, and local or regional anesthesia use.
Results:
Among 11169 patients, only 2328 (20.8%) were discharged opioid-free. Opioid-free discharge varied by procedure and was more common after minimally invasive surgery. In contrast, among patients prescribed opioids, dosing was relatively uniform across procedures and approaches, with most prescriptions ≤50 MME. Local or regional anesthesia did not translate into higher opioid-free discharge and was associated with slightly higher adjusted MME.
Conclusion:
These findings suggest that HPB discharge prescribing is driven more by the decision to prescribe than by dose selection, supporting procedure-specific opioid-sparing discharge pathways.
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