Postoperative surgical trainee opioid prescribing practices (POST-OPP): A national survey

David J. Hall, MD; Juan C. Mira, MD; Melissa R. Hoffman, MD, ND; Hari B. Keshava, MD, MS; Kevin R. Olsen, MD; John C. Hardaway, MD, PhD; Patrick W. Underwood, MD; Kristy L. Hawley, MD, MPH; Patricia L. Turner, MD; Ajay B. Antony, MD; Terrie Vasilopoulos, PhD; Nicolas J. Mouawad, MD, MPH, MBA

doi:10.5055/jom.2019.0516

Authors

David J. Hall, MD
Juan C. Mira, MD
Melissa R. Hoffman, MD, ND
Hari B. Keshava, MD, MS
Kevin R. Olsen, MD
John C. Hardaway, MD, PhD
Patrick W. Underwood, MD
Kristy L. Hawley, MD, MPH
Patricia L. Turner, MD
Ajay B. Antony, MD
Terrie Vasilopoulos, PhD
Nicolas J. Mouawad, MD, MPH, MBA

DOI:

https://doi.org/10.5055/jom.2019.0516

Keywords:

opioid prescribing education, surgical training, postoperative, opioid, pain management

Abstract

Background: Increasing opioid-related deaths have heightened focus on combating the opioid epidemic. The impact of surgical trainees on opioid-related deaths is unclear, and there is little data examining the association between trainee pain management education and opioid prescribing practices.

Methods: An anonymous, online survey was distributed to members of the Resident and Associate Society of the American College of Surgeons. The survey covered five themes: education and knowledge, prescribing practices, clinical case scenarios, policy, and beliefs and attitudes. Linear mixed models were used to evaluate the influence of respondent characteristics on reported morphine milligram equivalents (MME) prescribed for common general surgery clinical scenarios.

Results: Of 427 respondents, 54 percent indicated receiving training in postoperative pain management during medical school and 66 percent during residency. Only 35 percent agreed that they had received adequate training in prescribing opioids. There was a significant association between undergoing formal pain management training in medical school and prescribing fewer MME for common outpatient general surgery scenarios (94 ± 15.2 vs 108 ± 15.0; p = 0.003). Similarly, formal pain management training in residency was associated with prescribing fewer MME in the survey scenarios (92.6 ± 15.2 vs 109 ± 15.2; p = 0.002).

Conclusion: In this survey, nearly two-thirds of surgical residents felt that they were inadequately trained in opioid prescribing. Our findings additionally suggest that improving education may result in increased resident comfort with managing surgical pain, potentially leading to more responsible opioid prescribing. Further work will facilitate residency programs’ development of educational curricula for opioid prescribing best practices.

Author Biographies

David J. Hall, MD

Department of Surgery, University of Florida College of Medicine, Gainesville, Florida.

Juan C. Mira, MD

Department of Surgery, University of Florida College of Medicine, Gainesville, Florida.

Melissa R. Hoffman, MD, ND

Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina

Hari B. Keshava, MD, MS

Department of General Surgery, Cleveland Clinic Foundation, Cleveland, Ohio

Kevin R. Olsen, MD

Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida

John C. Hardaway, MD, PhD

Department of Surgical Oncology, Roger Williams Medical Center, Providence, Rhode Island

Patrick W. Underwood, MD

Department of Surgery, University of Florida College of Medicine, Gainesville, Florida

Kristy L. Hawley, MD, MPH

Department of Surgery, MedStar Union Memorial Hospital, Baltimore, Maryland

Patricia L. Turner, MD

Department of Surgery, University of Chicago Medicine, Chicago, Illinois

Ajay B. Antony, MD

Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida

Terrie Vasilopoulos, PhD

Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida

Nicolas J. Mouawad, MD, MPH, MBA

Department of Surgery, McLaren Bay Region, Bay City, Michigan; Department of Surgery, Michigan State University, Lansing, Michigan

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