Opioids After Surgery in the United States Versus the Rest of the World
Haytham M.A. Kaafarani, Kelsey Han, Mohamad El Moheb, Napaporn Kongkaewpaisan, Zhenyi Jia, Majed W. El Hechi, Suzanne F.M. Van Wijck, Kerry Breen, Ahmed Eid, Gabriel Rodriguez, Manasnun Kongwibulwut, Ask Tybjærg Nordestgaard, Joseph V. Sakran, Hiba Ezzeddine, Bellal Joseph, Mohammad Hamidi, Camilo Ortega, Sonia Lopez Flores, Bernardo Gutiérrez-Sougarret, Huanlong Qin, Jun Yang, Renyuan Gao, Zhiguo Wang, Zhiguang Gao, Supparerk Prichayudh, Said Durmaz, Gwendolyn van der Wilden, Stephanie Santin, Marcelo Augusto Fontenelle Ribeiro, Napakadol Noppakunsomboom, Ramzi S. Alami, Lara El-Jamal, Dana Naamani, George Velmahos, Keith D. Lillemoe
Abstract
OBJECTIVE: The International Patterns of Opioid Prescribing study compares postoperative opioid prescribing patterns in the United States (US) versus the rest of the world. SUMMARY OF BACKGROUND DATA: The US is in the middle of an unprecedented opioid epidemic. Diversion of unused opioids contributes to the opioid epidemic. METHODS: Patients ≥16 years old undergoing appendectomy, cholecystectomy, or inguinal hernia repair in 14 hospitals from 8 countries during a 6-month period were included. Medical records were systematically reviewed to identify: (1) preoperative, intraoperative, and postoperative characteristics, (2) opioid intake within 3 months preoperatively, (3) opioid prescription upon discharge, and (4) opioid refills within 3 months postoperatively. The median/range and mean/standard deviation of number of pills and OME were compared between the US and non-US patients. RESULTS: A total of 4690 patients were included. The mean age was 49 years, 47% were female, and 4% had opioid use history. Ninety-one percent of US patients were prescribed opioids, compared to 5% of non-US patients (P < 0.001). The median number of opioid pills and OME prescribed were 20 (0-135) and 150 (0-1680) mg for US versus 0 (0-50) and 0 (0-600) mg for non-US patients, respectively (both P < 0.001). The mean number of opioid pills and OME prescribed were 23.1 ± 13.9 in US and 183.5 ± 133.7 mg versus 0.8 ± 3.9 and 4.6 ± 27.7 mg in non-US patients, respectively (both P < 0.001). Opioid refill rates were 4.7% for US and 1.0% non-US patients (P < 0.001). CONCLUSIONS: US physicians prescribe alarmingly high amounts of opioid medications postoperatively. Further efforts should focus on limiting opioid prescribing and emphasize non-opioid alternatives in the US.