Health
General surgery accounts for a large proportion of opioid prescriptions for children and adults
A small number of the most common surgical procedures account for the majority of opioids prescribed after surgery in adults and children, a study published in 2010 found. JAMA Network Open and Pediatrics.1,2
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In adults, common surgical procedures such as cesarean section, laparoscopic cholecystectomy, and orthopedic surgery account for the majority of morphine milligram equivalents (MMEs) and opioid prescriptions prescribed to patients post-operatively.1
For children (0-11 years), the most common procedures for opioid prescriptions were tonsillectomy and/or adenoidectomy, removal of deep implants, and open repair of upper extremity fractures. For patients aged 12-21 years, the most common procedures were tonsillectomy and/or adenoidectomy, knee arthroscopy, and cesarean section.2
“Our findings suggest that opioid prescribing in surgery is concentrated in a small number of procedure groups. Efforts to ensure safe and appropriate surgical opioid prescribing should focus on these procedures,” said Kaoping Chua, lead author of the study. Pediatrics The assistant professor at the University of Michigan School of Medicine and Public Health said in a news release.3
The increase in opioid prescription rates nationwide coincides with a dramatic increase in opioid-related overdose deaths, and previous literature has demonstrated an association between opioid prescriptions for postoperative analgesia and opioid-related adverse events, including misuse and overdose.1
In JAMA Network Open In their analysis, the researchers conducted a national survey of post-surgical prescription use among privately and publicly insured non-elderly adults. They assessed which surgeries required the highest dose, frequency, and refills of post-operative opioid prescriptions, which they noted “may help target limited resources for surgical opioid management to those that will provide the greatest value.”1
The total sample size of surgical procedures was 1,040,934.Of these procedures, 503,058 (48.3%) of the total surgical procedures were associated with the issuance of an opioid prescription, and the number of patients with a prescription was 480,757 out of a total of 917,351 patients.1
Among those aged 18-44 years, cesarean section accounted for 19.4% (11,418,658) of the 58,825,364 MMEs, followed by hysterectomy (6.8%). [3,971,371 MMEs]) and knee arthroscopy (6.3% [3,681,759 MMEs]For people aged 45-64 years, four of the top five procedures were orthopedic procedures, accounting for 27.4% of the total MMEs prescribed for this age group.1
Opioid prescriptions prescribed to individuals aged 18-44 years were the most common procedure after cesarean section, accounting for 22.2% of all prescriptions (56,353 of 253,403), nearly three times as many as the next most common procedure, hysterectomy (8.0%). [20,348 prescriptions]Interestingly, laparoscopic cholecystectomy had the highest rate of individual prescriptions issued at 75.2% (18,449 of 24,523).1
In Pediatrics In this study, the researchers developed an algorithm to identify 1,082 major surgical procedures using procedure codes — a medical classification tool used to identify specific surgical, medical, or diagnostic interventions — similar to the aforementioned study that analyzed adult patients. They then applied this to identifying children with both private and public insurance.3
There were a total of 107,597 surgeries performed on patients aged 0 to 11 years. According to the researchers, the top three surgeries accounted for 59.1% of MMEs in postoperative opioid prescriptions: tonsillectomy and/or adenoidectomy (50.3%), open repair of upper extremity fractures (5.3%), and deep implant removal (3.5%).2
For patients aged 12–21 years, the top three procedures accounted for 33.1% of all MMEs and were tonsillectomy and/or adenoidectomy (12.7%), knee arthroscopy (12.6%), and cesarean section (7.8%).2 Cesarean section is the main procedure after which MME is prescribed in both adult and pediatric patients, highlighting the need for better management of patient treatment protocols to prevent patients from experiencing opioid-related adverse events.
“Our findings suggest that there is an important opportunity to reduce surgical opioid prescribing without compromising pain control,” said Dominique Alessio Bilous, lead author of the adult study published in 2010. JAMA Network Opensaid in a news release.3
References
1. Alessio-Bilowus D, Chua K, Peahl A, et al. Epidemiology of opioid prescribing following surgical discharge in adults. JAMA Network Open. 2024;7(6):e2417651. doi:10.1001/jamanetworkopen.2024.17651
2. Chua K, Brummett C, Kelly-Quon L, et al. Opioid Prescribing in Pediatric Surgery by Procedure, 2020-2021. Pediatrics2024;154(1):e2024065814. doi:10.1542/peds.2024-065814
3. Barnes K. Some surgical procedures contribute to high opioid prescribing. EurekAlert! News Release. Released June 28, 2024. Accessed July 11, 2024. https://www.eurekalert.org/news-releases/1049878
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