• Annals of surgery · Dec 2020

    Multicenter Study Comparative Study

    Opioids After Surgery in the United States Versus the Rest of the World: The International Patterns of Opioid Prescribing (iPOP) Multicenter Study.

    • KaafaraniHaytham M AHMADepartment of Surgery, Massachusetts General Hospital, Boston, Massachusetts., Kelsey Han, El MohebMohamadMDepartment of Surgery, Massachusetts General Hospital, Boston, Massachusetts., Napaporn Kongkaewpaisan, Zhenyi Jia, Majed W El Hechi, Suzanne van Wijck, Kerry Breen, Ahmed Eid, Gabriel Rodriguez, Manasnun Kongwibulwut, Ask T Nordestgaard, Joseph V Sakran, Hiba Ezzeddine, Bellal Joseph, Mohammad Hamidi, Camilo Ortega, Sonia Lopez Flores, Bernardo J Gutierrez-Sougarret, Huanlong Qin, Jun Yang, Renyuan Gao, Zhiguo Wang, Zhiguang Gao, Supparerk Prichayudh, Said Durmaz, Gwendolyn van der Wilden, Stephanie Santin, Marcelo A F Ribeiro, Napakadol Noppakunsomboom, Ramzi Alami, Lara El-Jamal, Dana Naamani, George Velmahos, and Keith D Lillemoe.
    • Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
    • Ann. Surg. 2020 Dec 1; 272 (6): 879-886.

    ObjectiveThe International Patterns of Opioid Prescribing study compares postoperative opioid prescribing patterns in the United States (US) versus the rest of the world.Summary Of Background DataThe US is in the middle of an unprecedented opioid epidemic. Diversion of unused opioids contributes to the opioid epidemic.MethodsPatients ≥16 years old undergoing appendectomy, cholecystectomy, or inguinal hernia repair in 14 hospitals from 8 countries during a 6-month period were included. Medical records were systematically reviewed to identify: (1) preoperative, intraoperative, and postoperative characteristics, (2) opioid intake within 3 months preoperatively, (3) opioid prescription upon discharge, and (4) opioid refills within 3 months postoperatively. The median/range and mean/standard deviation of number of pills and OME were compared between the US and non-US patients.ResultsA total of 4690 patients were included. The mean age was 49 years, 47% were female, and 4% had opioid use history. Ninety-one percent of US patients were prescribed opioids, compared to 5% of non-US patients (P < 0.001). The median number of opioid pills and OME prescribed were 20 (0-135) and 150 (0-1680) mg for US versus 0 (0-50) and 0 (0-600) mg for non-US patients, respectively (both P < 0.001). The mean number of opioid pills and OME prescribed were 23.1 ± 13.9 in US and 183.5 ± 133.7 mg versus 0.8 ± 3.9 and 4.6 ± 27.7 mg in non-US patients, respectively (both P < 0.001). Opioid refill rates were 4.7% for US and 1.0% non-US patients (P < 0.001).ConclusionsUS physicians prescribe alarmingly high amounts of opioid medications postoperatively. Further efforts should focus on limiting opioid prescribing and emphasize non-opioid alternatives in the US.

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