Evidence-based opioid prescribing guidelines after lung resection: a prospective, multicenter analysis

Jarred R Mondoñedo; Alexander A Brescia; Melissa J Clark; Matthew L Chang; Shannon Jiang; Chang He; Robert J Welsh; Andrew M Popoff; Mohan G Kulkarni; Shelly C Lall; Jerry W Pratt; Kumari N Adams; Raed M Alnajjar; James R Martin; Divyakant B Gandhi; Chad M Brummett; Andrew C Chang; Kiran H Lagisetty

doi:10.21037/jtd-22-1621

Evidence-based opioid prescribing guidelines after lung resection: a prospective, multicenter analysis

J Thorac Dis. 2023 Jun 30;15(6):3285-3294. doi: 10.21037/jtd-22-1621. Epub 2023 Jun 21.

Authors

Jarred R Mondoñedo¹, Alexander A Brescia¹, Melissa J Clark², Matthew L Chang¹, Shannon Jiang¹, Chang He², Robert J Welsh^{3

4}, Andrew M Popoff⁵, Mohan G Kulkarni⁶, Shelly C Lall⁷, Jerry W Pratt⁸, Kumari N Adams⁹, Raed M Alnajjar¹⁰, James R Martin¹¹, Divyakant B Gandhi¹², Chad M Brummett¹³, Andrew C Chang¹, Kiran H Lagisetty¹

Affiliations

¹ Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
² Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, MI, USA.
³ Beaumont Hospital, Royal Oak, MI, USA.
⁴ Beaumont Hospital, Troy, MI, USA.
⁵ Henry Ford Hospital, Detroit, MI, USA.
⁶ Henry Ford Allegiance Health, Jackson, MI, USA.
⁷ Munson Medical Center, Traverse City, MI, USA.
⁸ Ascension Borgess Hospital, Kalamazoo, MI, USA.
⁹ St. Joseph Mercy Ann Arbor, Ypsilanti, MI, USA.
¹⁰ Henry Ford Macomb Hospital, Clinton Township, MI, USA.
¹¹ McLaren Port Huron Hospital, Port Huron, MI, USA.
¹² McLaren Greater Lansing, Lansing, MI, USA.
¹³ Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA.

Abstract

Background: Opioid prescribing guidelines have significantly decreased overprescribing and post-discharge use after cardiac surgery; however, limited recommendations exist for general thoracic surgery patients, a similarly high-risk population. We examined opioid prescribing and patient-reported use to develop evidence-based, opioid prescribing guidelines after lung cancer resection.

Methods: This prospective, statewide, quality improvement study was conducted between January 2020 to March 2021 and included patients undergoing surgical resection of a primary lung cancer across 11 institutions. Patient-reported outcomes at 1-month follow-up were linked with clinical data and Society of Thoracic Surgery (STS) database records to characterize prescribing patterns and post-discharge use. The primary outcome was quantity of opioid used after discharge; secondary outcomes included quantity of opioid prescribed at discharge and patient-reported pain scores. Opioid quantities are reported in number of 5-mg oxycodone tablets (mean ± standard deviation).

Results: Of the 602 patients identified, 429 met inclusion criteria. Questionnaire response rate was 65.0%. At discharge, 83.4% of patients were provided a prescription for opioids of mean size 20.5±13.1 pills, while patients reported using 8.2±13.0 pills after discharge (P<0.001), including 43.7% who used none. Those not taking opioids on the calendar day prior to discharge (32.4%) used fewer pills (4.4±8.1 vs. 11.7±14.9, P<0.001). Refill rate was 21.5% for patients provided a prescription at discharge, while 12.5% of patients not prescribed opioids at discharge required a new prescription before follow-up. Pain scores were 2.4±2.5 for incision site and 3.0±2.8 for overall pain (scale 0-10).

Conclusions: Patient-reported post-discharge opioid use, surgical approach, and in-hospital opioid use before discharge should be used to inform prescribing recommendations after lung resection.

Keywords: Opioid prescribing; lung cancer; practice guidelines; thoracic surgery.