Discharging patients from the hospital 2 to 3 days after surgery was not found to be associated with rebound opioid refills, according to results of a study published in the Journal of Surgical Research.
This nonrandomized, prospective, quality improvement study was conducted from September to December 2019 at the University of Texas MD Anderson Cancer Center. Clinicians volunteered to use a 5x multiplier or usual-care prescribing protocol at patient discharge. The 5x protocol was defined as prescribing 5 times the patient’s previous 24-hour opioid use. Thirty-day refill rates were evaluated on the basis of prescribing method stratified by discharge day, in which short inpatient stay was defined as discharge on postoperative days 2 to 3 (n=154), intermediate stay as discharge on days 4 to 7 (n=176), and long stay as discharge 8 or more days after surgery (n=79), respectively.
The median age of the pooled patient population was 58.0 (interquartile range [IQR], 50.0-69.0) years, median length of stay was 4 (IQR, 3-7) days, 35% of study participants received preoperative opioids, 33.0% underwent minimally invasive surgery, 51.1% received 5x prescribing, and 48.9% received usual-care prescribing.
Median last oral morphine equivalents (OMEs) was 7.5 (IQR, 0-20.0) mg, discharge OME was 75.0 (IQR, 0-125.0) mg, 25.9% of patients did not receive opioids at discharge, 63.1% received 2 or more multimodal prescriptions at discharge, 15.9% refilled their prescriptions, and the refill OME dose was 300.0 (IQR, 112.5-900.0) mg. Stratified by length of stay, no significant differences in any opioid metrics were observed (all P ≥.093).
No trends were observed when stratifying by opioid-naive and opioid-experienced status.
Stratified by prescribing protocol, patients in the 5x arm had a lower prescribed dose of opioids compared with patients receiving usual-care prescribing (median OME, 50 vs 75 mg; P <.001).
A major limitation of this study was its nonrandomized design.
This study found that patients discharged after surgery had similar trends in opioid refill behaviors, regardless of length of stay. The researchers concluded, “Standardizing discharge opioid prescriptions is feasible in all inpatient surgery patients, regardless of length of stay, without risk of increased “rebound refills” in patients discharged following a short, uncomplicated inpatient stay.”
References:
DiPeri TP, Newhook TE, Cao HST, et al. Opioid discharge prescriptions after inpatient surgery: risks of rebound refills by length of stay. J Surg Res. 2022;278:111-118. doi:10.1016/j.jss.2022.04.057
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