D-H Study Proves Patients Need Fewer Opioid Painkillers After Surgery
Surgeons at Dartmouth-Hitchcock successfully reduced prescriptions for opioid painkillers by an average of 53 percent while still providing effective relief of their patient’s pain, according to a new study in The Annals of Surgery.
“By defining postoperative opioid requirements through patient surveys and disseminating operation-specific guidelines for opioid prescriptions to surgeons, we were able to decrease the number of opioids initially prescribed by more than half,” the researchers wrote. “Decreased initial opioid prescriptions did not result in increased opioid refill prescriptions.” In fact, less than 1 percent of patients prescribed the lower number of opioid pills required a refill of their opioid prescription.
It is estimated that deaths secondary to prescription opioid overdose have quadrupled in the past 15 years, and now reach almost 19,000 per year, said Richard J. Barth, Jr., MD, chief of General Surgery at D-H. Surgeons play an important role in this epidemic because opioids that are overprescribed and not used by those patients or may get diverted to others.
The new study follows last fall’s Dartmouth-Hitchcock research, also published in Annals of Surgery, that estimated patients actually need only a fraction of the opioid pain medications they are generally prescribed. “Patients were being given too many opioid pills and are only taking about 28 percent of what is prescribed,” Barth said of the initial study. “Our new study shows we can both prescribe far fewer opioids and relieve patients’ pain simply by educating patients – and surgeons – about what is an appropriate quantity of opioid pain medication for five common general surgical procedures, including breast surgeries, hernia repairs and gallbladder surgery.
Barth and colleagues offer this advice: “By incorporating these findings into practice it will be possible to both adequately treat patients’ postoperative pain and decrease the amount of unused opioid pills available for misuse, abuse or diversion.”
“Our ability to decrease opioid prescribing and use with an educational intervention at our institution implies that similar educational efforts at the state and national level will also be successful in markedly decreasing opioid prescribing by surgeons on a broader scale,” Barth wrote.
The Annals of Surgery paper offers specific data and recommendations – including the number of pills to be distributed for the five common surgeries.
“The first study showed us that there was a wide variation in the number of opioid pills prescribed to patients undergoing the same operation,” Barth explained. “For example, some patients undergoing gall bladder surgery were prescribed 10 pills, while others were prescribed 100 pills.”
The researchers attributed the variation in the number of pills prescribed to doctor’s perceptions that some patients were going to need more opioids than others and because of differences in the "standard" number of pills prescribed for a particular operation by a provider.
“By setting patient expectations preoperatively regarding the number of opioid pills that will be needed and by routinely incorporating the use of non-opioid analgesics such as ibuprofen and acetaminophen in the treatment of acute postoperative pain, we proved that we can prescribe fewer pain pills and that very few patients will request opioid refills,” Barth concluded.