Assessment of post-operative opioid prescribing practices in a community hospital ambulatory surgical center

Warren D. Bromberg, MD, FACS; Tracey Emanuel, MSN, RN, FNP-BC; Valerie Zeller, MA, RN; Elizabeth Galloway, BSN, RN, CAPA; Susan Mogan, DNP, ANP-BC, ACHPN, AP-PMN; Justin Diamond, BS; Debra Statler, RN III-C, BC; Fay Wright, PhD, RN, APRN-BC

doi:10.5055/jom.2021.0634

Authors

Warren D. Bromberg, MD, FACS
Tracey Emanuel, MSN, RN, FNP-BC
Valerie Zeller, MA, RN
Elizabeth Galloway, BSN, RN, CAPA
Susan Mogan, DNP, ANP-BC, ACHPN, AP-PMN
Justin Diamond, BS https://orcid.org/0000-0003-4243-4387
Debra Statler, RN III-C, BC
Fay Wright, PhD, RN, APRN-BC

DOI:

https://doi.org/10.5055/jom.2021.0634

Keywords:

surgeons, surgery, opioids, postoperative, prescribing, guidelines, outpatient

Abstract

Objective: To evaluate the prescribing practices and opioid consumption in an ambulatory setting to inform the development of evidence-based guidelines.

Design: A prospective study of adults undergoing outpatient open and laparoscopic surgeries over 3 months. One week after discharge, a telephonic interview quantified the number of opioids prescribed and consumed, degree of pain control and satisfaction, and whether additional pain medication was requested.

Setting: Community hospital ambulatory surgery center in Westchester County, New York.

Participants: This study included 304 adults undergoing a variety of procedures by surgeons from multiple specialties.

Main outcome measures: Quantify surgeons’ postoperative opioid prescribing compared with patient opioid consumption.

Results: Eighty-one percent (N = 245) responded to the survey, of which 64 percent were prescribed opioids. Males and females were equally represented with the mean age of 59.4 years. Of those prescribed opioids, 92 percent filled the prescription. The most commonly prescribed opioids reported by the patients that filled their prescription (N = 145) were oxycodone (36.5 percent), oxycodone/acetaminophen (28.9 percent), and tramadol (22.7 percent). The mean number of opioid pills prescribed was 20 and the mean consumption was 6.7 pills, resulting in an average of 13 retained pills. Only 3.8 percent of the patients prescribed opioids at discharge called their provider for additional analgesia. Despite the low opioid consumption patients reported high satisfaction (4.5 on scale of 0-5) with pain control. Only 10.4 percent reported that the surgeon recommended an over the counter (OTC) analgesic option. There was variability in the amount of opioids prescribed within each surgical category.

Conclusions: One week after outpatient surgery, patients consumed one-third of physician-prescribed opioids, yet they reported high pain management satisfaction. Our study will inform the development of a patient-centered interdisciplinary perioperative education program to more effectively tailor multimodal pain management in ambulatory surgical patients and collaterally reduce the number of retained opioids.

Author Biographies

Warren D. Bromberg, MD, FACS

Center for Robotic Surgery, Northern Westchester Hospital/Northwell Health, Mount Kisco, New York; Division of Urology, Northern Westchester Hospital Northwell Health, Mount Kisco, New York

Tracey Emanuel, MSN, RN, FNP-BC

Emergency Department, Northern Westchester Hospital, Mount Kisco, New York

Valerie Zeller, MA, RN

Northern Westchester Hospital, Mount Kisco, New York

Elizabeth Galloway, BSN, RN, CAPA

Northern Westchester Hospital, Mount Kisco, New York

Susan Mogan, DNP, ANP-BC, ACHPN, AP-PMN

Northern Westchester Hospital, Mount Kisco, New York

Justin Diamond, BS

Donald and Barbara Zucker School of Medicine, Hofstra/Northwell, Hempstead, New York

Debra Statler, RN III-C, BC

Northern Westchester Hospital, Mount Kisco, New York

Fay Wright, PhD, RN, APRN-BC

Northern Westchester Hospital, Mount Kisco, New York; New York University Rory Meyers College of Nursing, New York, New York

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