Varghese said after accounting for patient factors, including pain, the surgery type, and patient comorbidities, the quantity of opioids prescribed at discharge was independently associated with increased use of opioids.
“Generally, surgeons prescribe double the number of opioids a patient consumes in the first week after surgery,” he said.
“The more opioids we prescribe, the more a patient uses at home, and this is not explained by differences in pain levels.”
The study found prescribing more opioids did not improve the experience of pain or satisfaction with pain relief given, but it increased the risk of side effects.
“We send patients home with too many opioids after surgery,” he said.
“The over-prescription of opioids is not a problem isolated to the United States, it’s an issue in Aotearoa New Zealand too.”
This global study aimed to identify factors that drive increased opioid consumption a week after discharge from common surgical procedures.
“We need to better tailor opioid prescriptions to individual patients, there is no one size fits all answer,” Varghese said.
“This research offers doctors and patients real-world data to guide when an opioid is needed, and if an opioid is being prescribed, how much opioid is typically used by patients. The data will help us think more carefully about our pain relief prescriptions so it’s tailored to patients’ needs.”
The doctors and researchers at Middlemore and Whangarei Hospital found the quantity of opioids prescribed at discharge to be independently linked with a 30 per cent increase in opioid consumption.
Recruited from 144 hospitals across 25 countries, 4273 patients with a median age of 50 participated in the study.
These patients underwent 19 common surgeries, and at discharge 1311 were prescribed an opioid painkiller, a median 100 milligrams or 10 tablets of 10 mg sevredol.
Seven days after surgery, a median of just 40 milligrams - or four tablets of 10 mg sevredol - had been consumed.
Further analysis showed having opioids did not improve patients’ pain when they were at home, however, it did increase the risk of opioid side effects.
The research is an international, multicentre, prospective cohort study that looked at general surgical, urological, gynaecological, and orthopaedic surgery with a seven-day post-discharge phone call follow-up.
It was conducted by Trials and Audits in Surgery by medical students in Aotearoa New Zealand and Australia (TASMAN) Collaborative, and the results will be presented at the Royal Australasian College of Surgeons Annual Scientific Congress that runs from today (May 1) until Friday.
According to the NZ Drug Foundation, 171 people died from overdose in 2021, and 46 are believed to be from opioid overdose.
