Prescribing Habits of Providers and Risk Factors for Nonadherence to Opioid Prescribing Guidelines

• Published in: The American surgeon 2021-07, Vol.87 (7), p.1039-1047
• Main Authors: Ivanics, Tommy, Nasser, Hassan, Kandagatla, Pridvi, Leonard-Murali, Shravan, Jones, Adam, Abouljoud, Marwan, Gupta, Arielle Hodari, Woodward, Ann
• Format: Article
• Language: English
• Subjects: Appendectomy; Cholecystectomy; Confidence intervals; Electronic health records; General Medicine; Guidelines; Hernia; Hispanic people; Laparoscopy; Morphine; Narcotics; Nurse practitioners; Opioids; Oxycodone; Pain; Patient satisfaction; Prescriptions; Risk analysis; Risk factors; Surgery; Target recognition; Variables
• ISSN: 0003-1348; 1555-9823; 1555-9823
• DOI: 10.1177/0003134820956332

Background The Michigan Opioid Prescribing Engagement Network introduced guidelines in October 2017 to combat opioid overprescription following various surgical procedures. We sought to evaluate changes in opioid prescribing at our academic center and identify factors associated with nonadherence to recently implemented opioid prescribing guidelines. Methods This retrospective review analyzed opioid prescribing data for appendectomy, cholecystectomy, and hernia repair from January 2015 through September 2017 (pre-guidelines group) and November 2017 through December 2018 (post-guidelines group). October 2017 data were excluded to allow for guideline implementation. Opioid prescribing data were recorded as total morphine equivalents (TMEs). Results Of 1493 cases (903 pre-vs. 590 post-guidelines), the mean TME prescribed significantly decreased post-guidelines (231.9 ± 108.6 vs. 112.7 ± 73.9 mg; P < .01). More providers prescribed within recommended limits post-guidelines (2.8% vs. 44.8%; P < .01). On multivariable analysis, independent risk factors for guideline nonadherence were the American Society of Anesthesiologists class > 2 (adjusted odds ratio [AOR]:1.65, 95% confidence interval[CI] 1.09-2.49; P = .02), general surgery vs. acute care surgery service (AOR 1.89, 95% CI 1.15-3.10; P = .01), oxycodone vs. hydrocodone (AOR:1.90, 95% CI:1.06-3.41; P = .03), and nonphysician provider vs. resident prescriber (AOR:2.10, 95% CI:1.14-3.11; P < .01). Conclusions Opioid prescribing significantly reduced after the adoption of opioid prescribing guidelines at our institution. Numerous factors associated with provider guideline nonadherence may identify actionable targets to minimize opioid overprescribing further.