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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


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.


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

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Levy B, Paulozzi L, Mack KA, et al.: Trends in opioid analgesic-prescribing rates by specialty, U.S., 2007-2012. Am J Prev Med. 2015; 49(3): 409-413.

Brummett CM, Waljee JF, Goesling J, et al.: New persistent opioid use after minor and major surgical procedures in US adults. JAMA Surg. 2017; 152(6): e170504.

Sun EC, Darnall BD, Baker LC, et al.: Incidence of and risk factors for chronic opioid use among opioid-naive patients in the postoperative period. JAMA Intern Med. 2016; 176(9): 1286-1293.

Hill MV, McMahon ML, Stucke RS, et al.: Wide variation and excessive dosage of opioid prescriptions for common general surgical procedures. Ann Surg. 2017; 265(4): 709-714.

Olsen KR, Hall DJ, Mira JC, et al.: Postoperative surgical trainee opioid prescribing practices (POST OPP): An institutional study. J Surg Res. 2018; 229(9): 58-65.

Bicket MC, Long JJ, Pronovost PJ, et al.: Prescription opioid analgesics commonly unused after surgery: A systematic review. JAMA Surg. 2017; 152(11): 1066-1071.

Bartels K, Mayes LM, Dingmann C, et al.: Opioid use and storage patterns by patients after hospital discharge following surgery. PLoS One. 2016; 11(1): e0147972.

Saluja S, Selzer D, Meara JG, et al.: The opioid epidemic: What can surgeons do about it? Bull Am Coll Surg. 2017; 102(7): 13-18.

Ruff AL, Alford DP, Butler R, et al.: Training internal medicine residents to manage chronic pain and prescription opioid misuse. Subst Abus. 2017; 38(2): 200-204.

Alford DP, Carney BL, Brett B, et al.: Improving residents’ safe opioid prescribing for chronic pain using an objective structured clinical examination. J Grad Med Educ. 2016; 8(3): 390-397.

Antman KH, Berman HA, Flotte TR, et al.: Developing core competencies for the prevention and management of prescription drug misuse: A medical education collaboration in Massachusetts. Acad Med. 2016; 91(10): 1348-1351.

Chiu AS, Healy JM, DeWane MP, et al.: Trainees as agents of change in the opioid epidemic: Optimizing the opioid prescription practices of surgical residents. J Surg Educ. 2018; 75(1): 65-71.

Dowell D, Haegerich TM, Chou R: CDC guideline for prescribing opioids for chronic pain—United States, 2016. JAMA. 2016; 315(15): 1624-1645.

Von Korff M, Saunders K, Thomas Ray G, et al.: De facto long-term opioid therapy for noncancer pain. Clin J Pain. 2008; 24(6): 521-527.

Wong RL, Sullivan MC, Yeo HL, et al.: Race and surgical residency: Results from a national survey of 4339 US general surgery residents. Ann Surg. 2013; 257(4): 782-787.

Stain SC, Hiatt JR, Ata A, et al.: Characteristics of highly ranked applicants to general surgery residency programs. JAMA Surg. 2013; 148(5): 413-417.

Nooromid MJ, Mansukhani NA, Deschner BW, et al.: Surgical interns: Preparedness for opioid prescribing before and after a training intervention. Am J Surg. 2018; 215(2): 238-242.

Yorkgitis BK, Bryant E, Raygor D, et al.: Opioid prescribing education in surgical residencies: A program director survey. J Surg Educ. 2018; 75(3): 552-556.

Hill MV, Stucke RS, McMahon ML, et al.: An educational intervention decreases opioid prescribing after general surgical operations. Ann Surg. 2018; 267(3): 468-472.

Chiu AS, Ahle SL, Freedman-Weiss MR, et al.: The impact of a curriculum on postoperative opioid prescribing for novice surgical trainees. Am J Surg. 2019; 217(2): 228-232.

Taylor JL, Rapoport AB, Rowley CF, et al.: An opioid overdose curriculum for medical residents: Impact on naloxone prescribing, knowledge, and attitudes. Subst Abus. 2018; 39(3): 371-376.

Jones CM, Paulozzi LJ, Mack KA: Sources of prescription opioid pain relievers by frequency of past-year nonmedical use United States, 2008-2011. JAMA Intern Med. 2014; 174(5): 802-803.

Howard R, Waljee JF, Brummett CM, et al.: Reduction in opioid prescribing through evidence-based prescribing guidelines. JAMA Surg. 2018; 153(3): 285-287.

Hill MV, Stucke RS, Billmeier SE, et al.: Guideline for discharge opioid prescriptions after inpatient general surgical procedures. J Am Coll Surg. 2018; 226(6): 996-1003.

Yarger JB, James TA, Ashikaga T, et al.: Characteristics in response rates for surveys administered to surgery residents. Surgery. 2013; 154(1): 38-45.

Powell AC, Casey K, Liewehr DJ, et al.: Results of a national survey of surgical resident interest in international experience, electives, and volunteerism. J Am Coll Surg. 2009; 208(2): 304-312.



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