Abstract
OBJECTIVE: To investigate the relationships among opioid prescribing, consumption, and patient-reported outcomes (PROs) in patients undergoing emergency surgery. BACKGROUND: Overprescribing of opioids for pain management after surgery has become a public health concern and a major contributor to opioid misuse and dependency. Current guidelines do not address opioid prescribing after emergency surgical procedures, highlighting the importance of understanding the relationship between opioid prescribing and consumption in this setting. METHODS: Retrospective analysis of the quantity of opioids prescribed and PROs in a population-based setting. The sample included adults ≥18 years undergoing emergency surgery across 69 hospitals in Michigan. Patients were included if they received a discharge opioid prescription and had valid data for opioid consumption and PROs. Surgical procedures took place between January 1, 2018 and December 31, 2020. RESULTS: During the study period, a total of 3742 patients underwent an emergency operation. The mean number of opioid pills prescribed was 9.6 and the mean number of opioid pills consumed was 4.6. In a 2-model with logit in the first part and a linear regression in the second, prescription size was significantly associated with both the probability of consumption (adjusted odds ratio: 1.02; 95% CI: 1.01-1.04) and the amount of consumption conditional on any consumption (coefficient: 0.70; 95% CI: 0.54-0.86). CONCLUSIONS: Patients only consumed half of the opioids they were prescribed after undergoing emergency surgery. In addition, patients who were given larger prescriptions consumed more opioids, but did not experience less pain, higher satisfaction, better quality of life, or less regret to undergo surgery. Overall, this suggests that opioids may be excessively prescribed to patients undergoing emergency surgical procedures and that larger prescriptions do not improve the patient experience after surgery.