Breaking News
May 3, 2019 - Vaping and Smoking May Signal Greater Motivation to Quit
May 3, 2019 - Dementia looks different in brains of Hispanics
May 3, 2019 - Short-Staffed Nursing Homes See Drop In Medicare Ratings
May 3, 2019 - Study of teens with eating disorders explores how substance users differ from non-substance users
May 3, 2019 - Scientists develop new video game that may help in the study of Alzheimer’s
May 3, 2019 - Arc Bio introduces Galileo Pathogen Solution product line at ASM Clinical Virology Symposium
May 3, 2019 - Cornell University study uncovers relationship between starch digestion gene and gut bacteria
May 3, 2019 - How to Safely Use Glucose Meters and Test Strips for Diabetes
May 3, 2019 - Anti-inflammatory drugs ineffective for prevention of Alzheimer’s disease
May 3, 2019 - Study tracks Pennsylvania’s oil and gas waste-disposal practices
May 3, 2019 - Creating a better radiation diagnostic test for astronauts
May 3, 2019 - Vegans are often deficient in these four nutrients
May 3, 2019 - PPDC announces seed grants to develop medical devices for children
May 3, 2019 - Study maps out the frequency and impact of water polo head injuries
May 3, 2019 - Research on Reddit identifies risks associated with unproven treatments for opioid addiction
May 3, 2019 - Good smells may help ease tobacco cravings
May 3, 2019 - Medical financial hardship found to be very common among people in the United States
May 3, 2019 - Researchers develop multimodal system for personalized post-stroke rehabilitation
May 3, 2019 - Study shows significant mortality benefit with CABG over percutaneous coronary intervention
May 3, 2019 - Will gene-editing of human embryos ever be justifiable?
May 3, 2019 - FDA Approves Dengvaxia (dengue vaccine) for the Prevention of Dengue Disease in Endemic Regions
May 3, 2019 - Why Tonsillitis Keeps Coming Back
May 3, 2019 - Fighting the opioid epidemic with data
May 3, 2019 - Maggot sausages may soon be a reality
May 3, 2019 - Deletion of ATDC gene prevents development of pancreatic cancer in mice
May 2, 2019 - Targeted Therapy Promising for Rare Hematologic Cancer
May 2, 2019 - Alzheimer’s disease is a ‘double-prion disorder,’ study shows
May 2, 2019 - Reservoir bugs: How one bacterial menace makes its home in the human stomach
May 2, 2019 - Clinical, Admin Staff From Cardiology Get Sneak Peek at Epic
May 2, 2019 - Depression increases hospital use and mortality in children
May 2, 2019 - Vicon and NOC support CURE International to create first gait lab in Ethiopia
May 2, 2019 - Researchers use 3D printer to make paper organs
May 2, 2019 - Viral infection in utero associated with behavioral abnormalities in offspring
May 2, 2019 - U.S. Teen Opioid Deaths Soaring
May 2, 2019 - Opioid distribution data should be public
May 2, 2019 - In the Spotlight: “I’m learning every single day”
May 2, 2019 - 2019 Schaefer Scholars Announced
May 2, 2019 - Podcast: KHN’s ‘What The Health?’ Bye-Bye, ACA, And Hello ‘Medicare-For-All’?
May 2, 2019 - Study describes new viral molecular evasion mechanism used by cytomegalovirus
May 2, 2019 - SLU study suggests a more equitable way for Medicare reimbursement
May 2, 2019 - Scientists discover first gene involved in lower urinary tract obstruction
May 2, 2019 - Researchers identify 34 genes associated with increased risk of ovarian cancer
May 2, 2019 - Many low-income infants receive formula in the first few days of life, finds study
May 2, 2019 - Global study finds high success rate for hip and knee replacements
May 2, 2019 - Taking depression seriously: What is it?
May 2, 2019 - With Head Injuries Mounting, Will Cities Put Their Feet Down On E-Scooters?
May 2, 2019 - Scientists develop small fluorophores for tracking metabolites in living cells
May 2, 2019 - Study casts new light into how mothers’ and babies’ genes influence birth weight
May 2, 2019 - Researchers uncover new brain mechanisms regulating body weight
May 2, 2019 - Organ-on-chip systems offered to Asia-Pacific regions by Sydney’s AXT
May 2, 2019 - Adoption of new rules drops readmission penalties against safety net hospitals
May 2, 2019 - Kids and teens who consume zero-calorie sweetened beverages do not save calories
May 2, 2019 - Improved procedure for cancer-related erectile dysfunction
May 2, 2019 - Hormone may improve social behavior in autism
May 2, 2019 - Alzheimer’s disease may be caused by infectious proteins called prions
May 2, 2019 - Even Doctors Can’t Navigate Our ‘Broken Health Care System’
May 2, 2019 - Study looks at the impact on criminal persistence of head injuries
May 2, 2019 - Honey ‘as high in sugars as table sugar’
May 2, 2019 - Innovations to U.S. food system could help consumers in choosing healthy foods
May 2, 2019 - FDA Approves Mavyret (glecaprevir and pibrentasvir) as First Treatment for All Genotypes of Hepatitis C in Pediatric Patients
May 2, 2019 - Women underreport prevalence and intensity of their own snoring
May 2, 2019 - Concussion summit focuses on science behind brain injury
May 2, 2019 - Booker’s Argument For Environmental Justice Stays Within The Lines
May 2, 2019 - Cornell research explains increased metastatic cancer risk in diabetics
May 2, 2019 - Mount Sinai study provides fresh insights into cellular pathways that cause cancer
May 2, 2019 - Researchers to study link between prenatal pesticide exposures and childhood ADHD
May 2, 2019 - CoGEN Congress 2019: Speakers’ overviews
May 2, 2019 - A new strategy for managing diabetic macular edema in people with good vision
May 2, 2019 - Sagent Pharmaceuticals Issues Voluntary Nationwide Recall of Ketorolac Tromethamine Injection, USP, 60mg/2mL (30mg per mL) Due to Lack of Sterility Assurance
May 2, 2019 - Screen time associated with behavioral problems in preschoolers
May 2, 2019 - Hormone reduces social impairment in kids with autism | News Center
May 2, 2019 - Researchers synthesize peroxidase-mimicking nanozyme with low cost and superior catalytic activity
May 2, 2019 - Study results of a potential drug to treat Type 2 diabetes in children announced
May 2, 2019 - Multigene test helps doctors to make effective treatment decisions for breast cancer patients
May 2, 2019 - UNC School of Medicine initiative providing unique care to dementia patients
May 2, 2019 - Nestlé Health Science and VHP join forces to launch innovative COPES program for cancer patients
May 2, 2019 - Study examines how our brain generates consciousness and loses it during anesthesia
May 2, 2019 - Transition Support Program May Aid Young Adults With Type 1 Diabetes
May 2, 2019 - Study shows how neutrophils exacerbate atherosclerosis by inducing smooth muscle-cell death
May 2, 2019 - Research reveals complexity of how we make decisions
Surgery patients use only 1/4 of prescribed opioids, and prescription size matters

Surgery patients use only 1/4 of prescribed opioids, and prescription size matters

A representation of the proportion of prescribed opioid pain medication that surgical patients actually took, in a statewide study in Michigan. Prescription size was the main predictor of how many opioid pills patients took after surgery. Credit: University of Michigan

Many surgeons write prescriptions for opioid pain medications four times larger than what their patients will actually use after common operations, a new study shows.

And the size of that prescription may be the most important factor in how many opioid pills the patient will take—outweighing their pain scores, the intensity of their operation and personal factors, the research suggests.

The study, published in JAMA Surgery by a team from the University of Michigan that has studied many aspects of surgical opioids, highlights the importance of using real-world information about surgical patient opioid use to guide prescribing. It also points to a need to provide options for surgical patients to dispose of unused opioids safely, so that the pills aren’t misused or lead to a poisoning or overdose.

The study used in-depth data from 2,392 patients who had one of 12 different common operations at 33 Michigan hospitals. On average, patients took only 27 percent of all opioids prescribed to them. But for every 10 additional pills prescribed, patients took five of them.

The researchers used data from patients who had their operations in 2017, at hospitals that participate in the Michigan Surgical Quality Collaborative, a statewide effort to improve surgical care based on shared data and analysis.

The study focuses on a time period after broad public awareness of the opioid epidemic, but before the launch of surgical opioid prescribing recommendations developed at U-M. Those recommendations, based on data from patients at, U-M’s academic medical center Michigan Medicine, now guide surgical prescribing at all MSQC hospitals.

“It’s striking to see the major discrepancy between prescribed amount and the amount patients actually take,” says Joceline Vu, M.D., senior author of the new paper and a surgical resident and research fellow at Michigan Medicine, U-M’s academic medical center. “This is not a phenomenon of a few outlier surgeons—it was seen across the state, and across many operations.”

Ryan Howard, M.D., the surgical resident who is the paper’s first author, adds, “In what we tell patients about what kind of pain to expect after surgery, and how many pills we give, we set their expectations—and what the patient expects plays a huge role in their post-operative pain experience. So if they get 60 pain pills, they think they have to take many of them.”

Vu and Howard note that psychology research has dubbed this the anchoring and adjustment heuristic, where the baseline data someone receives—the size of a plate of food, for instance—makes a difference in how much they consume.

The research team was done as part of the Michigan Opioid Prescribing and Engagement Network, or Michigan-OPEN, led by two U-M surgical faculty and an anesthesiologist specializing in pain medicine. One of the surgeons, Michael Englesbe, M.D., also heads the MSQC.

Funded by Blue Cross Blue Shield of Michigan, MSQC provided a natural laboratory to study surgical opioid prescribing and use. In addition to tracking prescription information, MSQC worked with hospital staff to start a program of calling patients one month and three months after their operations, to ask them about their pain medication use, level of pain and other topics.

The median number of pills patients received was 30—but the median number used was nine. The number of pills a patient received was the strongest predictive factor of the number they used. The next strongest was the patient’s self-reported memory of whether they had no pain, or moderate or severe pain in their first week after surgery: those who said they had severe pain took 16 more opioid pills than those with no pain.

Tobacco users tended to use more opioids after surgery, while the older a patient was, the fewer opioid pills they tended to take. Not surprisingly, those who had outpatient surgery took fewer opioids, but those who went into their operation with worse underlying health (as measured by the American Society of Anesthesiologists classification system) used more.

The researchers also compare patients’ opioid across different surgical procedures. Patients who had a hernia repaired—whether through open surgery or minimally invasively—used the most opioids among the 12 operations studied. Patients who had their appendix or thyroid taken out took the least.

The researchers did not have information on mental health diagnoses that the patients might have had, specifically depression and substance use disorders, which other U-M research has shown to be associated with higher rates of prolonged opioid use after surgery.

They also didn’t have information on each patient’s prior prescriptions for opioids, or use of opioids before surgery. The U-M team has previously shown that those who go into surgery already taking prescription opioids have worse outcomes and a higher likelihood of going on to prolonged use of opioids long after surgical pain should have diminished.

Howard notes that other research has suggested that the more opioid medication a patient is prescribed for surgical or non-surgical pain, the higher their risk of developing an addiction to opioids or overdosing. Other research has shown that many people addicted to opioids of any kind began their opioid use with pills prescribed to them, or taken from others around them.

He says, “We hope that by shining a spotlight on the difference between prescription size and actual use, we can empower surgeons to change their prescribing habits, and be a better steward to both their patient and the broader community.”

Vu, Howard and their colleagues are working to update the surgical prescribing guidelines, adding more procedures. They also hope to work with other collaborative quality initiatives funded by BCBSM and led by U-M physicians, to repeat the study in other patient populations. Now that MSQC hospitals use surgical opioid prescribing guidelines, they will study the before-and-after trends in prescribing and use.


Explore further:
How many opioid pain pills do surgery patients need? New prescribing guide available

More information:
JAMA Surgery (2018). jamanetwork.com/journals/jamas … 1/jamasurg.2018.4234

Journal reference:
JAMA Surgery

Provided by:
University of Michigan

Tagged with:

About author

Related Articles