D-H opioid study presents new guidelines after surgeries

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D-H opioid study presents new guidelines after surgeries

Tue, 12/05/2017 - 5:48am -- tim

Vermont Business Magazine A new study by Dartmouth-Hitchcock’s Chief of Surgery Dr Richard Barth offers surgeons specific guidelines for post-surgery prescriptions for pain-relieving opioids. The study, published in the Journal of the American College of Surgeons, recommends that patients who have major abdominal surgery should be able to control their pain at home by taking the same number of opioids they took the day before they were discharged.

“This guideline was true for multiple different operations,” Dr. Barth said.  “It didn’t matter whether someone had a colon operation, liver procedure or hernia repair; no matter what type of general surgery operation they had, this association held throughout all procedures studied.  So the beauty of this finding is that one guideline would apply for multiple different surgical procedures.”

This is the first time that specific guidelines have been proposed for prescribing opioids upon discharge after general surgery operations that require inpatient admission, according to the peer-reviewed Journal article. 

Although some states have adopted laws to curb opioid prescriptions, they are ambiguous.  Barth noted that several New England states limit doctors to prescribing a seven-day supply of opioids, but they include no limits on dosing.  “So a seven-day supply could be 84 pills or 21 pills,” he said.

Rising rates of opioid prescriptions have been linked to the national epidemic, and a significant number of opioid deaths have been linked to prescriptions written by surgeons

This is the third post-surgery study by Barth and his research team. Two previous studies showed that most outpatient surgeries for breast, gall bladder and hernia repair needed far fewer opioid pain medications than currently prescribed. Generally, Barth said in the first studies, there was no published data to guide physicians for controlling post-surgical pain.

The outpatient studies helped educate D-H providers and patients that a regimen of acetaminophen and ibuprofen could control 85 percent of post-surgical pain, resulting in a 53 percent reduction in opioid use by surgical outpatients.

Barth’s new study offers guidelines for inpatient surgery prescriptions “that are easy to remember and easy to use” for providers and patients, he said. The recommendation does not mean patients won’t get enough pills to manage their pain after they leave the hospital.  “The guideline was based on satisfying at least 85 percent of patients’ home opioid requirement,” Dr Barth said.

The study included 333 hospital inpatients discharged to home after six different types of general surgery operations:  bariatric procedures; operations on the stomach, liver, and pancreas; ventral hernia repair; and colon operations.  The researchers followed up with the patients after discharge by using questionnaires and phone surveys; 90 percent of the discharged patients completed the follow-up process.  The study group did not include any chronic opioid users.

The guideline recommends the following schedule for post-discharge prescription based on the number of opioid pills taken the day before discharge:

  • no pills for patients who took no opioids the day before they left the hospital;
  • 15 pills for those who took one to three pills the day before;
  • 30 pills for those who took four or more pills on their last day in the hospital

“This guideline was true for multiple different operations,” Dr Barth said.  “It didn’t matter whether someone had a colon operation, liver procedure or hernia repair; no matter what type of general surgery operation they had, this association held throughout all procedures studied.  So the beauty of this finding is that one guideline would apply for multiple different surgical procedures.”

Barth says other D-H departments will study the recommendations in the coming year.

Source: LEBANON, NH -- D-H. DARTMOUTH-HITCHCOCK (D-H) is a nonprofit academic health system serving communities in northern New England. D-H provides access to more than 1,000 primary care doctors and specialists in almost every area of medicine at Dartmouth-Hitchcock Medical Center; the Norris Cotton Cancer Center, the Children’s Hospital at Dartmouth-Hitchcock, four affiliate hospitals, 24 ambulatory clinics and through the Visiting Nurse and Hospice for VT and NH. The D-H system trains nearly 400 residents and fellows annually, and performs world-class research, in partnership with the Audrey and Theodor Geisel School of Medicine at Dartmouth and the White River Junction VA Medical Center.