Tags

Type your tag names separated by a space and hit enter

Opioid Prescribing Patterns After Anorectal Surgery.
J Surg Res. 2020 11; 255:632-640.JS

Abstract

BACKGROUND

Anorectal procedures are frequently performed and have the potential to be particularly painful. There are no evidence-based guidelines regarding opioid prescribing after anorectal surgery and limited data on how surgeons determine opioid prescriptions after anorectal procedures. We hypothesize significant variations in prescribing practices. The aim of this study is to determine current opioid prescribing patterns after anorectal surgery.

METHODS

A survey was sent to members of the American Society of Colon and Rectal Surgeons. It included demographics, opioid prescribing habits after anorectal procedures, and factors influencing prescribing. Median morphine equivalents were calculated. Respondents prescribing higher than the median for >4 procedures were considered high prescribers.

RESULTS

519 surveys were completed (3160 sent). 38.6% of respondents were high prescribers, and 61.4% were low prescribers. There were significant differences by years in practice (P = 0.049), hospital type (P = 0.037), region (P < 0.001), and procedures performed per month (P < 0.001). 73% prescribed a standard quantity of opioids for each procedure. The mean milligrams of ME prescribed overall was 129 (SD 82); by procedure the quantities were as follows: hemorrhoidectomy 188 (111), condyloma treatment 149 (105), fistulotomy 146 (98), advancement flap 144 (97), LIFT 140 (93), abscess drainage 107 (91), sphincterotomy 105 (85), chemodenervation 64 (34). Nearly, all (98%) surgeons used local anesthesia. 91% typically prescribed adjunctive medications. In multivariable analysis, performing <10 anorectal procedures per month or practicing in the Northeast or outside the US was associated with low prescribers. High prescribers were more likely to be in practice for >10 y, report >25% of patients request refills, or significantly consider patient satisfaction or phone calls when prescribing.

CONCLUSIONS

Opioid prescribing patterns are highly variable after anorectal procedures. Creating opioid prescribing guidelines for anorectal surgery is important to improve patient safety and quality of care.

Authors+Show Affiliations

University of Nebraska Medical Center, Omaha., Nebraska.Case Western Reserve University School of Medicine, Cleveland, OH.University Hospitals Cleveland Medical Center/UH-RISES: Research in Surgical Outcomes & Effectiveness Center), Cleveland, OH.Case Western Reserve University School of Medicine, Cleveland, OH; University Hospitals Cleveland Medical Center/UH-RISES: Research in Surgical Outcomes & Effectiveness Center), Cleveland, OH.University Hospitals Cleveland Medical Center/UH-RISES: Research in Surgical Outcomes & Effectiveness Center), Cleveland, OH.Case Western Reserve University School of Medicine, Cleveland, OH; University Hospitals Cleveland Medical Center/UH-RISES: Research in Surgical Outcomes & Effectiveness Center), Cleveland, OH.Case Western Reserve University School of Medicine, Cleveland, OH; University Hospitals Cleveland Medical Center/UH-RISES: Research in Surgical Outcomes & Effectiveness Center), Cleveland, OH. Electronic address: emily.steinhagen@uhhospitals.org.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32663700

Citation

Leinicke, Jennifer A., et al. "Opioid Prescribing Patterns After Anorectal Surgery." The Journal of Surgical Research, vol. 255, 2020, pp. 632-640.
Leinicke JA, Carbajal V, Senders ZJ, et al. Opioid Prescribing Patterns After Anorectal Surgery. J Surg Res. 2020;255:632-640.
Leinicke, J. A., Carbajal, V., Senders, Z. J., Patil, N., Wogsland, A., Stein, S. L., & Steinhagen, E. (2020). Opioid Prescribing Patterns After Anorectal Surgery. The Journal of Surgical Research, 255, 632-640. https://doi.org/10.1016/j.jss.2020.05.098
Leinicke JA, et al. Opioid Prescribing Patterns After Anorectal Surgery. J Surg Res. 2020;255:632-640. PubMed PMID: 32663700.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Opioid Prescribing Patterns After Anorectal Surgery. AU - Leinicke,Jennifer A, AU - Carbajal,Valerie, AU - Senders,Zachary J, AU - Patil,Nirav, AU - Wogsland,Aric, AU - Stein,Sharon L, AU - Steinhagen,Emily, Y1 - 2020/07/11/ PY - 2020/01/16/received PY - 2020/05/12/revised PY - 2020/05/24/accepted PY - 2020/7/15/pubmed PY - 2020/7/15/medline PY - 2020/7/15/entrez KW - Anorectal KW - Opioids KW - Prescribing SP - 632 EP - 640 JF - The Journal of surgical research JO - J Surg Res VL - 255 N2 - BACKGROUND: Anorectal procedures are frequently performed and have the potential to be particularly painful. There are no evidence-based guidelines regarding opioid prescribing after anorectal surgery and limited data on how surgeons determine opioid prescriptions after anorectal procedures. We hypothesize significant variations in prescribing practices. The aim of this study is to determine current opioid prescribing patterns after anorectal surgery. METHODS: A survey was sent to members of the American Society of Colon and Rectal Surgeons. It included demographics, opioid prescribing habits after anorectal procedures, and factors influencing prescribing. Median morphine equivalents were calculated. Respondents prescribing higher than the median for >4 procedures were considered high prescribers. RESULTS: 519 surveys were completed (3160 sent). 38.6% of respondents were high prescribers, and 61.4% were low prescribers. There were significant differences by years in practice (P = 0.049), hospital type (P = 0.037), region (P < 0.001), and procedures performed per month (P < 0.001). 73% prescribed a standard quantity of opioids for each procedure. The mean milligrams of ME prescribed overall was 129 (SD 82); by procedure the quantities were as follows: hemorrhoidectomy 188 (111), condyloma treatment 149 (105), fistulotomy 146 (98), advancement flap 144 (97), LIFT 140 (93), abscess drainage 107 (91), sphincterotomy 105 (85), chemodenervation 64 (34). Nearly, all (98%) surgeons used local anesthesia. 91% typically prescribed adjunctive medications. In multivariable analysis, performing <10 anorectal procedures per month or practicing in the Northeast or outside the US was associated with low prescribers. High prescribers were more likely to be in practice for >10 y, report >25% of patients request refills, or significantly consider patient satisfaction or phone calls when prescribing. CONCLUSIONS: Opioid prescribing patterns are highly variable after anorectal procedures. Creating opioid prescribing guidelines for anorectal surgery is important to improve patient safety and quality of care. SN - 1095-8673 UR - https://www.unboundmedicine.com/medline/citation/32663700/Opioid_Prescribing_Patterns_After_Anorectal_Surgery_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-4804(20)30381-4 DB - PRIME DP - Unbound Medicine ER -