The association of multimodal analgesia and high-risk opioid discharge prescriptions in opioid-naive surgical patients

Erica Langnas; Rosa Rodriguez-Monguio; Yanting Luo; Rhiannon Croci; R Adams Dudley; Catherine L Chen

doi:10.1186/s13741-021-00230-3

The association of multimodal analgesia and high-risk opioid discharge prescriptions in opioid-naive surgical patients

Perioper Med (Lond). 2021 Dec 15;10(1):60. doi: 10.1186/s13741-021-00230-3.

Authors

Erica Langnas¹, Rosa Rodriguez-Monguio^{2

3

4}, Yanting Luo⁴, Rhiannon Croci⁵, R Adams Dudley⁶, Catherine L Chen^{7

4}

Affiliations

¹ Department of Anesthesia and Perioperative Care, University of California, San Francisco, 513 Parnassus Ave, S455, San Francisco, CA, 94143, USA. Erica.Langnas@ucsf.edu.
² Department of Clinical Pharmacy, University of California, San Francisco, San Francisco, USA.
³ Medication Outcomes Center, University of California, San Francisco, San Francisco, USA.
⁴ Philip R. Lee Institute for Health Policy Studies at the University of California, San Francisco, San Francisco, USA.
⁵ UCSF Health Informatics, University of California, San Francisco, San Francisco, USA.
⁶ Department of Medicine, University of Minnesota, Minneapolis, USA.
⁷ Department of Anesthesia and Perioperative Care, University of California, San Francisco, 513 Parnassus Ave, S455, San Francisco, CA, 94143, USA.

Abstract

Background: Opioids and multimodal analgesia are widely administered to manage postoperative pain. However, little is known on how improvements in inpatient pain control are correlated with high-risk (> 90 daily OME) discharge opioid prescriptions for opioid naïve surgical patients.

Methods: We conducted a retrospective observational study of adult opioid-naïve patients undergoing surgery from June 2012 through December 2018 at a large academic medical center. We used multivariate logistic regression to assess whether multimodal analgesic drugs consumed in the 24 h prior to discharge was associated with a reduction in high-risk opioid discharge prescriptions. We identified other risk factors for receiving a high-risk discharge opioid prescription.

Results: Among the 32,511 patients, 83% of patients were discharged with an opioid prescription. In 2013, 34.1% of patients with a discharge opioid prescription received a high-risk prescription and this declined to 17.7% by 2018. Use of multimodal analgesic agents during the final 24 h of hospitalization increased each year, with over 80% receiving at least one multimodal analgesic agent by 2018. The median OME consumed in the 24 h prior to discharge peaked in 2013 at 31 and steadily decreased to 19.8 by 2018. There was a significant association between the use of acetaminophen in the 24 h prior to discharge and a high-risk prescription at discharge (p < 0.01). OMEs consumed in the 24 h prior to discharge was a significant predictor of receiving a high-risk discharge prescription, even at low doses. Other factors associated with receipt of a high-risk discharge opioid prescription included male gender, race, history of anxiety disorder, and discharge service.

Discussion: Use of multimodal analgesia regimens in hospitalized surgical patients in the 24 h prior to hospital discharge increased between 2012 and 2018. Simultaneously, opioid use prior to hospital discharge decreased. Despite these gains, approximately one in five discharge prescriptions was high-risk (> 90 daily OME). In addition, we found that prescribing of discharge opioids above inpatient opioid requirements remains common in opioid naive surgical patients.

Conclusion: Providers should account for pre-discharge opioid consumption and use of multimodal analgesia when considering the total and daily OME's that may be appropriate for an individual surgical patient on the discharge opioid prescription.

Keywords: Multimodal analgesia; Opioids; Oral morphine equivalents; Postoperative pain; Prescribing practices.

Grants and funding

K23 AG072035/AG/NIA NIH HHS/United States