Temporal trends in opioid prescribing for common general surgical procedures in the opioid crisis era

Background: Recent data has demonstrated that postoperative patients are at risk of chronic opioid abuse. It is unknown whether surgeon postoperative opioid prescribing changed as the opioid crisis entered its peak. Methods: The Institutional Data Warehouse was queried to identify patients who underwent three common elective ambulatory procedures between 2014 and 2018 (n = 3495), including: laparoscopic cholecystectomy, laparoscopic inguinal hernia repair (IHR), and open IHR. The main outcome of interest was opioid pills prescribed, converted to an equianalgesic pill number (1 pill = 5 mg oxycodone). Results: Postoperative opioid prescribing was stable from 2014 to 2016 then decreased significantly in 2017 and 2018 (p < 0.0001). While the median number of pills prescribed remained stable at 30 between 2014 and 2018, the frequency of patients receiving 30 pills decreased significantly. Multivariate analysis demonstrated significantly fewer pills prescribed postoperatively after 2016. Conclusions: Reductions in postoperative pills prescribed over time as the opioid crisis worsened suggests that surgeons may be considering the potential for opioid abuse and diversion. Persistently high median number of pills prescribed and continued variation in number of pills prescribed suggests room for further improvement.