Time From Operation to Discharge Correlates With Opioid Prescription Patterns After Appendectomy
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Andrea K Watters1, Brendan P Stewart1, Avishag Ashkenazi2
1Department of Surgery, UConn Health, Farmington, Connecticut.
Introduction:
Prior studies have analyzed pediatric opioid prescription patterns following appendectomy, but data in adults remain limited. This study aims to identify factors that are associated with opioid prescription patterns following emergent appendectomy.
Methods:
A retrospective review of the 2024 American College of Surgeons National Surgical Quality Improvement Program database was performed for adult patients undergoing emergent appendectomy discharged with an opioid prescription, stratified by surgical approach. Patient factors, perioperative outcomes, and prescription characteristics were evaluated. Logistic regressions were performed to determine the odds of opioid prescription and renewal.
Results:
Patients undergoing open appendectomy received fewer opioids (33.9%) than those undergoing laparoscopic (61.7%) and robotic (52.1%) surgery. Postoperative hospital stay was longer after open appendectomy (5.8 d) than laparoscopic (1.3 d) and robotic (1.2 d) approaches. Time from operation to discharge decreased the odds of being prescribed opioids on discharge (odds ratio 0.78). Oxycodone was most prescribed (61.7%), followed by hydromorphone (15.4%) and tramadol (15.0%). The median quantity of pills prescribed was 10, with a median duration of 2 d. A total of 0.62% of patients had a prescription refilled. No patient factors were associated with opioid renewal.
Conclusions:
We hypothesize that the lower opioid prescriptions after open appendectomy compared to minimally invasive approaches may be attributed to longer postoperative hospital stay, allowing for a narcotic weaning period. Opioid prescriptions following emergent appendectomy in adults are limited in duration and quantity, with low refill rates-0.62% nationally. Although there is adherence to opioid stewardship guidelines, postoperative opioid prescribing patterns vary greatly.
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