Too many opiates handed out for surgeries

June 21, 2021

Treating post-surgery pain with non-opioid pain medications, such as ibuprofen or acetaminophen, didn’t lead to higher pain levels or more serious issues during recovery, and didn’t dampen patients’ satisfaction with their care, according to new results from a study of more than 22,000 patients who had one of seven common operations at 70 hospitals.

The new study was published in the Annals of Surgery by a team from Michigan Medicine, the University of Michigan’s academic medical center. They analyzed 2019 data from a Michigan-wide surgical care registry, and surveyed patients about their experience after they’d had a chance to recover.

The vast majority, 86%, of the patients received a prescription for an opioid after they had hernia, gallbladder, appendix, bowel, thyroid or gynecological operations.

But when the researchers compared those patients’ experiences and survey responses with data from the 14% of patients who only got non-opioid painkiller prescriptions, they found little difference.

Specifically, there was no difference in complications, emergency department visits, or reoperations between groups. Patients not prescribed opioids were slightly more likely to be readmitted to the hospital, but rarely due to pain-related issues.

In all, 82% of both groups – patients who got an opioid prescription, and those who did not – said they were highly satisfied with their care. An even higher, but still equal, percentage of both groups (93%) said they had no regret about their surgery.

Those who didn’t receive opioid prescriptions were actually more likely to report no pain in the first week after surgery than those who did (12% vs 7%). The non-opioid patients were also slightly more likely to say they had the best possible quality of life after surgery (66% vs 63%).

Another new paper, led by fellow Michigan OPEN Co-Director Chad Brummett, MD, uses national insurance claims data to document new persistent opioid use and costs of care for surgical patients who had not been taking opioids before their operations. It’s published in the June issue of the Journal of Managed Care and Specialty Pharmacy.

That study shows that between 4% and 7% of all patients who had surgery that required a hospital stay went on to fill opioid prescriptions months after their surgical pain should have faded, which the authors called new persistent opioid use. The same was true for between 1.5% and 6.4% of patients who had an outpatient operation. In this study, none of the patients had been filling opioid prescriptions before their operation.

These patients went on to have more hospital and emergency care in the following year, compared with those who didn’t fill a single opioid prescription immediately after their operation.

While some of the patients who didn’t fill an opioid prescription after surgery did go on to receive opioids for other reasons later in the follow-up year, those who started on opioids after surgery received five times more opioid prescriptions and much higher overall health care costs.

Visit University of Michigan for more news