Purpose: To examine opiate pain medication prescription and consumption after surgical procedures at VCU Medical Center

Pflugrath, Adam

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Masthead LogoVirginia Commonwealth UniversityVCU Scholars CompassHealth Sciences Education Symposium School of Medicine2019A Guide to Prescribing Sufficient Post SurgicalQuantities of Opiate Pain MedicationsAdam PflugrathVCUFollow this and additional works at: https://scholarscompass.vcu.edu/med_eduPart of the Medicine and Health Sciences Commons© The Author(s)This Poster is brought to you for free and open access by the School of Medicine at VCU Scholars Compass. It has been accepted for inclusion in HealthSciences Education Symposium by an authorized administrator of VCU Scholars Compass. For more information, please contact libcompass@vcu.edu.Downloaded fromhttps://scholarscompass.vcu.edu/med_edu/74Purpose & BackgroundPurpose: To examine opiate pain medication prescription and consumption after surgical procedures at VCU Medical Center.Background: There is a national concern regarding the prescription of opiatepain medications and the rise of opiate overdose related deaths in the UnitedStates.1 As of 2017, the odds of dying by opioid overdose were greater thanthose of dying in a motor vehicle crash.1 46 people die every day secondaryto an overdose involving prescription opioids.1 Few studies are available toassist surgeons in prescribing post-surgical opiate pain medications. Patel etal found that 63.7% of prescribed opiate pain medications were unusedfollowing rhinoplasty.3 Bates et al found that 42% of prescribed opiate painmedications were not consumed after urology procedures; 67% had excessmedication, most of which was not disposed of properly.5A Guide to Prescribing Sufficient Post Surgical Quantities of Opiate Pain MedicationsAdam Pflugrath MD1, Nikisha Richards MD1, Dev Sahni2, Angela Gupta21Virginia Commonwealth University Health Department of Ophthalmology2Virginia Commonwealth University School of MedicineMethodsSurveys were distributed in the waiting rooms of outpatient clinics topatients who had recently undergone various procedures by Neurosurgery,Ophthalmology, Oral and Maxillofacial Surgery (OMFS), Orthopedics,Otolaryngology (ENT) and Plastic Surgery. The survey was anonymous andobtained information regarding the type of opiate pain medication, numberof opiates prescribed, number of opiates consumed, number of priorsurgeries requiring opiate pain medications, knowledge of disposal of opiatepain medications, age, ethnicity, surgical subspecialty and surgicalprocedure performed.Results59 surveys were distributed from April 2018-February 2019 to willingparticipants. 47 (79.7%) surveys were completed. 17 surveys were obtainedfrom OMFS, 12 from Orthopedics, 11 from ophthalmology, 5 fromneurosurgery and 1 each from ENT and Plastic Surgery. Overall, an averageof 20-30 opiate pain pills were prescribed and 10-20 pills were consumed(p=0.001). Oxycodone was the most commonly prescribed opiate painmedication (48.9%) followed by hydrocodone (27.7%). The mostcommonly performed procedure was 'Other' (n=14, 29.8%). Of patients whoresponded with 'Other' for the procedure performed, 39.6% of opiate painmedications were not consumed. Patients who underwent tooth extraction(n=10, 21.3%), did not consume 25% of prescribed opiate pain medications.12.8% of patients (n=6) who underwent eyelid/eyebrow surgery did notconsume 11.1% of prescribed opiate pain medications. Patients whounderwent repair of a non-facial bone fracture (n=5, 10.6%), did notconsume 26.9% of prescribed opiate pain medications. 10.6% of patients(n=5) who underwent repair of facial bone fractures, did not consume 38.5%of opiate pain medications. There was no difference in the number ofprescribed opiate pain medications in those who had multiple prior surgeriesrequiring opiates and those who were opiate naive (p=0.67). The mostcommon disposal methods for left over opiate pain medications were 'other'(31.9%), followed by garbage (25.5%), not disposed (19.15%) and disposedin the sink or toilet (10.6%). 53.2% of patients surveyed were aware of freedisposal of opiates at local law enforcement agencies.ConclusionsThe prescribing practices of post-operative opiate painmedications were variable. In many cases, there were a largenumber of opiate pain pills not consumed, which is consistentwith comparable studies.2-6 Further education on proper disposalmethods is needed in our patient population. Over the course ofthe study, a small number of surveys were returned. More patientresponses are needed to make adequate recommendations onnumber of opiates to be prescribed for certain surgicalprocedures. One limitation is that this study is a patient surveystudy and thus recall and response biases play roles in theaccuracy of this study. Patient medical record review foraccuracy of survey results paired with patient phone calls wouldhelp improve the quality of the information collected.References1.Drug Overdose Death Data. Centers for Disease Control and Prevention. https://www.cdc.gov/drugoverdose/data/overdose.html. Aug, 1, 2017.2.Mutlu I, Abubaker O, Laskin DM. Narcotic prescribing habits and other methods of pain control by oral and maxillofacial surgeons after impacted third molar removal. J Oral Maxillofac Surg. 2013;71:1500 – 1503.3.Patel, S., Sturm, A., Bobian, M., Svider, P.F., Zuliani, G. and Kridel, R., 2018. Opioid use by patients after rhinoplasty. JAMA facial plastic surgery, 20(1), pp.24-30.4.Rodgers J, Cunningham K, Fitzgerald K, et al. Opioid consumption following outpatient upper extremity surgery. J Hand Surg Am. 2012;37A:645–650.5.Bates C, Laciak R, Southwick A, et al. Overprescription of postoperative narcotics: A look at postoperative pain medication delivery, consumption and disposal in urologic practice. J Urol. 2011;185:551 – 555.6.Hill, M.V., McMahon, M.L., Stucke, R.S. and Barth Jr, R.J., 2017. Wide variation and excessive dosage of opioid prescriptions for common general surgical procedures. Annals of surgery, 265(4), pp.709-714.49%28%17%4%2%Oxycodone Hydrocodone Other Morphine Hydromorphone0.12.525.37.550.Other Tooth Extraction Eyelid/Eyebrow Surgery Facial Bone Repair Repair of non-Facial Bone Facial LacerationOpiate Pain Medication Prescribed vs Consumed by Surgical ProcedureAverage Prescribed Average ConsumedGarbage26%Sink/Toilet11%Pharmacy0%Designated Site13%Not Disposed19%Other32%DisposalMethodCommonly Prescribed Opiate Pain Medications

A Guide to Prescribing Sufficient Post Surgical Quantities of Opiate Pain Medications

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A Guide to Prescribing Sufficient Post Surgical Quantities of Opiate Pain Medications

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