Opioid prescription at postoperative discharge: a retrospective observational cohort study

Daliya, P.; Adiamah, A.; Roslan, F.; Theophilidou, E.; Knaggs, R.D.; Levy, N.; Lobo, D.N.

Abstract

Opioid misuse is now considered a major public health epidemic in North America, with substantial social and financial consequences. As well as socio-economic and commercial drivers, modifiable risk-factors that have resulted in this crisis have been identified. The purpose of this study was to identify whether, within England, modifiable drivers for persistent postoperative opioid use were present. This was a retrospective cohort study of practice at 14 National Health Service hospitals across England. Data were collected retrospectively and validated for adult patients undergoing elective intermediate and major or complex major general surgical procedures between 1 and 31 March 2019. Of the 509 patients enrolled from 14 centres, 499 were included in the data analysis. In total, 31.5% (157/499) patients were in the intermediate surgery cohort and 68.5% (342/499) were in the major or complex major surgery cohort, with 21.0% (33/157) and 21.6% (74/342) discharged with opioid medicines to be taken at regular intervals, respectively. There were similar median oral morphine equivalent doses prescribed at discharge. Of patients prescribed regular opioid medicines, 76.6% (82/107) had a specified duration at discharge. However, 72.9% (78/107) had no written deprescribing advice on discharge. Similarly, of patients prescribed ‘when required’ opioids, 59.6% (93/156) had a specified duration of their prescription and 33.3% (52/156) were given written deprescribing advice. This study has identified a pattern of poor prescribing practices, a lack of guidance and formal training at individual institutions and highlights opportunities for improvement in opioid-prescribing practices within England.

Citation

Daliya, P., Adiamah, A., Roslan, F., Theophilidou, E., Knaggs, R., Levy, N., & Lobo, D. (2021). Opioid prescription at postoperative discharge: a retrospective observational cohort study. Anaesthesia, 76(10), 1367-1376. https://doi.org/10.1111/anae.15460

• Journal Article Type: Article
• Acceptance Date: Feb 23, 2021
• Online Publication Date: Mar 25, 2021
• Publication Date: 2021-10
• Deposit Date: Mar 3, 2021
• Publicly Available Date: Mar 25, 2021
• Journal: Anaesthesia
• Print ISSN: 0003-2409
• Electronic ISSN: 1365-2044
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 76
• Issue: 10
• Pages: 1367-1376
• DOI: https://doi.org/10.1111/anae.15460
• Keywords: Anesthesiology and Pain Medicine
• Public URL: https://nottingham-repository.worktribe.com/output/5364900
• Publisher URL: https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/anae.15460
• Additional Information: Authors on behalf of the Opioid prescription at postoperative discharge (OPiOiD) Study Group.; ; This article is accompanied by an editorial by Albrechet and Brummett, Anaesthesia 2021; 76: 1304–7. https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/anae.15480