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

Haytham M.A. Kaafarani, Kelsey Han, Mohamad El Moheb, 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 QinJun 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, Keith D. Lillemoe

Research output: Contribution to journalArticlepeer-review

14 Scopus citations

Abstract

OBJECTIVE: The 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 DATA: The US is in the middle of an unprecedented opioid epidemic. Diversion of unused opioids contributes to the opioid epidemic. METHODS: Patients ≥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. RESULTS: A 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). CONCLUSIONS: US 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.

Original languageEnglish (US)
Pages (from-to)879-886
Number of pages8
JournalAnnals of surgery
Volume272
Issue number6
DOIs
StatePublished - Dec 1 2020

ASJC Scopus subject areas

  • Surgery

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