WASHINGTON -- Too much or too little opioid pain management at discharge after urologic surgery significantly increased the likelihood of refills, providing new insight into opioid overuse, according to a study reported here.
More than 60% of patients received discharge opioid prescriptions that were mismatched with their last in-hospital opioid dose, with underdosing accounting for a third of the mismatches. As compared with patients who received matched opioid doses at discharge, overprescription increased the odds for additional refills by as much as 85% and underprescription increased the odds by as much as 47%.
The frequency of overprescription decreased during the 8-year study period, whereas underprescription accounted for an increasingly larger share of mismatched prescriptions, reported Walter Hsiang, MD, of the University of California San Francisco (UCSF), at the American Urological Association annual meeting.
"We saw that both overprescription and underprescription independently contributed to opioid refills at 90 days," said Hsiang. "I think it's very important to emphasize, both within our study, but also in numerous studies in other surgical specialties, that total opioid dose reduction alone has not really been shown to decrease opioid refills. The takeaway is that we should be focusing on a patient-centered opioid-prescribing approach."
