State and federal efforts to curb surging opioid overdose rates often include capping initial opioid prescriptions at seven days. However, many surgical patients may require prescription refills after the seven-day supply is exhausted, according to a study published in JAMA Surgery.
To determine the optimal length of opioid prescriptions for various surgical procedures, researchers analyzed opioid prescription data from the Department of Defense Military Health System Data Repository. The team identified data on 215,140 opioid-naive individuals aged 18 to 64 years who underwent one of eight common surgical procedures. Patients with a previous diagnosis of chronic pain were excluded from the study. Researchers divided surgical procedures into three categories: general surgery, musculoskeletal procedures and mastectomy or hysterectomy.
The amount of patients who required an opioid prescription refill after seven days varied from 11.3 percent to 39.3 percent based on procedure type. After applying a mathematical model to the data, researchers determined the optimal opioid prescription length was four days to nine days for general surgery, four days to 13 days for mastectomy or hysterectomy and six days to 15 days for musculoskeletal procedures.
"Although seven-day limits on initial opioid pain medication prescriptions are likely adequate in many settings, and indeed also sufficient for many common general surgery and gynecologic procedures, in the postoperative setting, particularly after many orthopedic and neurosurgical procedures, a seven-day limit may be inappropriately restrictive," concluded the study's authors. "Critically, further work is needed to better identify the 10 [percent] to 30 percent of patients who will require more intensive pain management to better tailor postoperative pain regimens to these individuals."
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