Defining Optimal Length of Opioid Pain Medication Prescription After Common Surgical Procedures
Open accessAbstract
Importance: The overprescription of pain medications has been implicated as a driver of the burgeoning opioid epidemic; however, few guidelines exist regarding the appropriateness of opioid pain medication prescriptions after surgery. Objectives: To describe patterns of opioid pain medication prescriptions after common surgical procedures and determine the appropriateness of the prescription as indicated by the rate of refills. Design, Setting, and Participants: The Department of Defense Military Health System Data Repository was used to identify opioid-naive individuals 18 to 64 years of age who had undergone 1 of 8 common surgical procedures between January 1, 2005, and September 30, 2014. The adjusted risk of refilling an opioid prescription based on the number of days of initial prescription was modeled using a generalized additive model with spline smoothing. Exposures: Length of initial prescription for opioid pain medication. Main Outcomes and Measures: Need for an additional subsequent prescription for opioid pain medication, or a refill. Results: Of the 215 140 individuals (107 588 women and 107 552 men; mean [SD] age, 40.1 [12.8] years) who underwent a procedure within the study time frame and received and filled at least 1 prescription for opioid pain medication within 14 days of their index procedure, 41 107 (19.1%) received at least 1 refill prescription. The median prescription lengths were 4 days (interquartile range [IQR], 3-5 days) for appendectomy and cholecystectomy, 5 days (IQR, 3-6 days) for inguinal hernia repair, 4 days (IQR, 3-5 days) for hysterectomy, 5 days (IQR, 3-6 days) for mastectomy, 5 days (IQR, 4-8 days) for anterior cruciate ligament repair and rotator cuff repair, and 7 days (IQR, 5-10 days) for discectomy. The early nadir in the probability of refill was at an initial prescription of 9 days for general surgery procedures (probability of refill, 10.7%), 13 days for women's health procedures (probability of refill, 16.8%), and 15 days for musculoskeletal procedures (probability of refill, 32.5%). Conclusions and Relevance: Ideally, opioid prescriptions after surgery should balance adequate pain management against the duration of treatment. In practice, the optimal length of opioid prescriptions lies between the observed median prescription length and the early nadir, or 4 to 9 days for general surgery procedures, 4 to 13 days for women's health procedures, and 6 to 15 days for musculoskeletal procedures.
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Previous studies have found that orthopedic trauma patients use a decreasing amount of opioid medication in the first 2 postoperative weeks, with 6-15 days being the optimal opioid use period.
“Previous studies have found that orthopedic trauma patients use a decreasing amount of opioid medication in the first 2 postoperative weeks, with 6-15 days being the optimal opioid use period [4,5].”
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Anthony, C. A., Rojas, E. O., Keffala, V., Glass, N. A., Shah, A. S., Miller, B. J., Hogue, M., Willey, M. C., Karam, M., & Marsh, J. L. (2020) · doi:10.2196/preprints.17750 · Cited by 64 · see citing works
“Previous studies have found that orthopedic trauma patients use a decreasing amount of opioid medication in the first 2 postoperative weeks, with 6-15 days being the optimal opioid use period [4,5].”
- Authors
- Scully, R. E., Schoenfeld, A. J., Jiang, W., Lipsitz, S., Chaudhary, M. A., Learn, P. A., Koehlmoos, T., Haider, A. H., & Nguyen, L. L.
- Affiliations
- Brigham and Women's Hospital (US)
- Uniformed Services University of the Health Sciences (US)
- Corresponding author
- Nguyen, Louis L.
- ORCID
- Venue
- JAMA Surgery
- Publisher
- American Medical Association (AMA)
- Published
- 2018-01-01
- Volume
- 153
- Issue
- 1
- Pages
- 37
- ISSN
- 2168-6254 (ISSN-L)
- PMC
- PMC5833616
- OpenAlex
- W2757001466
- Cited by
- 215
- References
- 6
- Citations by year
- 2026: 11 · 2025: 11 · 2024: 12 · 2023: 20 · 2022: 22 · 2021: 22 · 2020: 33 · 2019: 50 · 2018: 30 · 2017: 3
- FWCI
- 29.79
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA Surgery (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- eCommons - AKU (Aga Khan University) (submittedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Health Sciences › Medicine › Surgery › Anesthesia and Pain Management
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
- Keywords
- opioid analgesics, prescription refills, postoperative pain management, opioid overprescribing, opioid epidemic, surgical procedures, military health system, appendectomy, cholecystectomy, inguinal hernia repair, hysterectomy, mastectomy, anterior cruciate ligament repair, rotator cuff repair, discectomy, musculoskeletal surgery
- MeSH terms
- Adult, Analgesics, Opioid, Female, Humans, Male, Pain, Postoperative, Postoperative Pain, Drug Prescriptions, Surgical Procedures, Operative, United States, Cohort Studies
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