P-042 - Assessing Opioid Prescribing Practices for Opioid-Naïve Surgical Patients

Abstract Title: Assessing Opioid Prescribing Practices for Opioid-Naïve Surgical Patients

Background: In response to the opioid epidemic, there have been increased efforts to address the overprescribing of opioids and acknowledgement of the need for interventions, especially in post-surgical opioid naïve patients at time of hospital discharge. In the last 20 years, greater than 645,000 Americans have died as a result of an opioid overdose.¹ While the number of prescription medication events has decreased during this time period, it is estimated that upwards of 70% of all opioid disorder patients utilized prescription opioids._­­² Current literature has emphasized a concerning association between the number of refills of opioid prescriptions and a heightened risk of misuse among opioid-naïve patients. Prior retrospective cohort studies have found a 44% increase in the rate of misuse with each additional week of opioid use and refill.³



Purpose/Objectives: Evaluating the current discharge opioid prescribing patterns in the opioid naïve surgical patient population at OhioHealth Riverside Methodist Hospital (RMH) is vital for identifying opportunities to optimize practice and enhance patient safety. The purpose of this study was to evaluate adherence to the current OhioHealth Opioid Prescribing Guidelines for Opioid Naïve Surgical Patients. The institutional guideline was put into practice in February 2020, shortly before the Covid-19 pandemic. The widespread usage and adherence of this guideline is currently unknown and was evaluated throughout this study.




Methods: A retrospective chart review was performed, evaluating opioid prescription practices and institutional guideline adherence in opioid-naïve surgical patients discharged from a not-for-profit community hospital. Data was collected from January through July 2023 by utilizing a pharmacy guided data report via the electronic medical record. All patients >18 years of age that underwent a surgical procedure at RMH in the defined time period were considered for evaluation.

Ultimately, 14,178 surgeries occurred at RMH during the 6-month period. Of the surgeries, 6,662 met inclusion criteria and were further randomized to 2,000 for analysis.

The primary aim of this study was to determine the frequency of adherence to the institutional opioid prescribing guidelines for post-surgical opioid-naïve patients. The secondary aim was to determine if patient-specific factors were associated with an increase or decrease in opioid prescriptions at the time of discharge.


Results: Of the 14,178 patients screened for inclusion, 2,000 underwent randomization for analysis. 1,440 (72%) of the patients received a prescription for an opioid at discharge. 749 (37.5%) did not follow the opioid prescribing guidelines and were prescribed over the recommended amount of opioids. Age > 60 years (p< 0.001) was a significant factor that resulted in an increase in opioid prescribing. Level 2 surgical procedures (ex: ACL/PCL repair, Cesarean Section, Craniotomy) resulted in a decreased risk of overprescribing. Secondary outcomes assessed showed 989 (49.5%) patients received no additional or alternative pain medications (e.g. acetaminophen, NSAIDs, both) at discharge. Safety data showed that 54% (n=332) of patients receiving no opioids 24 hours prior to discharge were still prescribed an opioid prescription at hospital discharge. Lastly, 19% of the patients that received an opioid prescription were also prescribed naloxone at hospital discharge.

Conclusions/Implications for future research and/or clinical care: In conclusion, opioid prescribing in opioid naïve post-surgical patients at hospital discharge was in line with the institutional guideline for the majority of hospital discharges. Even so, there were a significant proportion of patients which still received larger than the recommended number of opioid tablets at discharge. Those most likely to receive a higher than recommended quantity included the elderly (age >60 years old). Based on these findings, the study reflected previous literature and supports the need for global clinical guidance surrounding post-surgical opioid prescribing, education around the use of the current institutional guideline and continued evaluation of the institutional guideline.




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