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Rigshospitalet - a part of Copenhagen University Hospital
E-pub ahead of print

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

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  • 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 Qin
  • Jun 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
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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
JournalAnnals of Surgery
ISSN0003-4932
DOIs
Publication statusE-pub ahead of print - 9 Jul 2020

ID: 60419026