An analysis of analgesia and opioid prescribing for veterans after thoracic surgery
Abstract The opioid crisis is a public health issue and has been linked to physician overprescribing. Pain management after thoracic surgery is not standardized at many centers, and we hypothesized that excessive narcotics were being dispensed on discharge. As a quality improvement initiative, we so...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Nature Portfolio
2020-07-01
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| Series: | Scientific Reports |
| Online Access: | https://doi.org/10.1038/s41598-020-68303-9 |
| _version_ | 1818991720502657024 |
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| author | Matthew J. Pommerening Aaron Landau Katherine Hrebinko James D. Luketich Rajeev Dhupar |
| author_facet | Matthew J. Pommerening Aaron Landau Katherine Hrebinko James D. Luketich Rajeev Dhupar |
| author_sort | Matthew J. Pommerening |
| collection | DOAJ |
| description | Abstract The opioid crisis is a public health issue and has been linked to physician overprescribing. Pain management after thoracic surgery is not standardized at many centers, and we hypothesized that excessive narcotics were being dispensed on discharge. As a quality improvement initiative, we sought to understand current prescribing practices to better align the amount of opioids dispensed on discharge to actual patient needs. This was a single-center, retrospective review of patients undergoing thoracic surgery from 7/2015 to 7/2018. Demographics, operative data, perioperative pain medication use, and discharge pain medication prescriptions were analyzed. Opioids were converted to Morphine Milligram Equivalents (MME). Among 124 patients, 103 (83%) received intraoperative nerve blocks and 106 (85.5%) used PCAs. Prescribed MME/day at discharge were significantly higher than MME/day received during hospitalization (Median 30 [IQR 30–45] vs. 15 [IQR 5–24], p < 0.001) and were not associated with receiving a nerve block or PCA. By procedure, prescribed MME/day were significantly higher than inpatient MME/day for wedge resections (p < 0.001), segmentectomies (p = 0.02), lobectomies (p = 0.003), and thymectomies (p = 0.02). Patients are being discharged with significantly more opioids than they are using as inpatients. Education among prescribers and a standardized approach with patient-specific dosing may reduce excessive opioid dispensing. |
| first_indexed | 2024-12-20T20:14:45Z |
| format | Article |
| id | doaj.art-f6eb55498ad24c2481c18c1113e7ef71 |
| institution | Directory Open Access Journal |
| issn | 2045-2322 |
| language | English |
| last_indexed | 2024-12-20T20:14:45Z |
| publishDate | 2020-07-01 |
| publisher | Nature Portfolio |
| record_format | Article |
| series | Scientific Reports |
| spelling | doaj.art-f6eb55498ad24c2481c18c1113e7ef712022-12-21T19:27:44ZengNature PortfolioScientific Reports2045-23222020-07-011011510.1038/s41598-020-68303-9An analysis of analgesia and opioid prescribing for veterans after thoracic surgeryMatthew J. Pommerening0Aaron Landau1Katherine Hrebinko2James D. Luketich3Rajeev Dhupar4Department of Cardiothoracic Surgery, University of Pittsburgh School of MedicineDepartment of Cardiothoracic Surgery, University of Pittsburgh School of MedicineDepartment of Cardiothoracic Surgery, University of Pittsburgh School of MedicineDepartment of Cardiothoracic Surgery, University of Pittsburgh School of MedicineDepartment of Cardiothoracic Surgery, University of Pittsburgh School of MedicineAbstract The opioid crisis is a public health issue and has been linked to physician overprescribing. Pain management after thoracic surgery is not standardized at many centers, and we hypothesized that excessive narcotics were being dispensed on discharge. As a quality improvement initiative, we sought to understand current prescribing practices to better align the amount of opioids dispensed on discharge to actual patient needs. This was a single-center, retrospective review of patients undergoing thoracic surgery from 7/2015 to 7/2018. Demographics, operative data, perioperative pain medication use, and discharge pain medication prescriptions were analyzed. Opioids were converted to Morphine Milligram Equivalents (MME). Among 124 patients, 103 (83%) received intraoperative nerve blocks and 106 (85.5%) used PCAs. Prescribed MME/day at discharge were significantly higher than MME/day received during hospitalization (Median 30 [IQR 30–45] vs. 15 [IQR 5–24], p < 0.001) and were not associated with receiving a nerve block or PCA. By procedure, prescribed MME/day were significantly higher than inpatient MME/day for wedge resections (p < 0.001), segmentectomies (p = 0.02), lobectomies (p = 0.003), and thymectomies (p = 0.02). Patients are being discharged with significantly more opioids than they are using as inpatients. Education among prescribers and a standardized approach with patient-specific dosing may reduce excessive opioid dispensing.https://doi.org/10.1038/s41598-020-68303-9 |
| spellingShingle | Matthew J. Pommerening Aaron Landau Katherine Hrebinko James D. Luketich Rajeev Dhupar An analysis of analgesia and opioid prescribing for veterans after thoracic surgery Scientific Reports |
| title | An analysis of analgesia and opioid prescribing for veterans after thoracic surgery |
| title_full | An analysis of analgesia and opioid prescribing for veterans after thoracic surgery |
| title_fullStr | An analysis of analgesia and opioid prescribing for veterans after thoracic surgery |
| title_full_unstemmed | An analysis of analgesia and opioid prescribing for veterans after thoracic surgery |
| title_short | An analysis of analgesia and opioid prescribing for veterans after thoracic surgery |
| title_sort | analysis of analgesia and opioid prescribing for veterans after thoracic surgery |
| url | https://doi.org/10.1038/s41598-020-68303-9 |
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