Opioids Limit Post-Surgery Patient Satisfaction

A new study has challenged concerns that limiting opioid pain medication prescriptions to a five-day supply might negatively impact surgery patients’ recovery. The research, conducted in Michigan, found that the patient-reported levels of pain and satisfaction did not change for individuals who had common surgeries, such as appendix or gallbladder removal, hernia repair, or hysterectomy, following the implementation of a five-day limit on opioid prescriptions by the state’s largest insurer, Blue Cross Blue Shield of Michigan (BCBSM).

Instead, the study demonstrated a reduction in the amount of opioid pain medication patients received, with an average decrease of about three pills per patient. Published in JAMA Health Forum by a team from Michigan Medicine, the academic medical center of the University of Michigan, this study represents the first substantial investigation into how opioid prescribing limits affect the patient experience following surgery. 

The lead author of the study, Kao-Ping Chua, M.D., Ph.D., highlighted the significance of understanding the impact of these limits on patient experience, saying, “Opioid prescribing limits are now everywhere, so understanding their effects is crucial. We know these limits can reduce opioid prescribing, but it hasn’t been clear until now whether they can do so without worsening patient experience.” 

Surprisingly, even the 15% of patients who had been taking opioids for other reasons before their surgeries did not report increased pain or decreased satisfaction after the implementation of the five-day limit, despite the reduction in opioid prescribing. This unintended reduction was designed to target patients who hadn’t taken opioids recently. 

Chua and several of the study’s co-authors are affiliated with the U-M Opioid Research Institute and the Institute for Health Care Policy and Innovation. They have played a role in developing evidence-based surgical opioid prescribing guidelines, recommending non-opioid pain relief, and limiting prescriptions to no more than ten opioid pills for most of the operations considered in the study. 

To conduct the study, Chua and his colleagues’ combined data from the Michigan Surgical Quality Collaborative, which collects data on patients undergoing common surgeries at 70 Michigan hospitals. This data includes postoperative surveys on pain, satisfaction, and regret. 

The research team matched anonymized data from the Michigan Surgical Quality Collaborative with data from the state’s prescription drug monitoring program, known as MAPS, tracking controlled substance prescription fills. The study included 1,323 BCBSM patients who had common surgeries during the 13 months preceding the implementation of the five-day limit and 4,722 patients who had surgeries in the 20 months following the limit. 

The demographic makeup of both groups was similar, with around 86% being non-Hispanic white, an average age of just under 49, and nearly a quarter undergoing emergency or urgent procedures. Almost 50% were admitted to the hospital for at least one night. 

Approximately 27% of both groups had laparoscopic gallbladder removals, while a similar percentage underwent minor hernia repairs. Approximately 10% had laparoscopic appendectomies, and laparoscopic hysterectomies, while the remainder had more invasive surgeries, such as open hysterectomies, major hernia repairs, or colon removals. 

The study did not find any significant change in the percentage of prescribers who prescribed opioids to their patients, but the percentage of patients who filled opioid prescriptions decreased, possibly because pharmacists rejected prescriptions that exceeded the BCBSM limit. 

Reference 

Changes in Surgical Opioid Prescribing and Patient-Reported Outcomes After Implementation of an Insurer Opioid Prescribing Limit, JAMA Health Forum (2023). DOI: 10.1001/jamahealthforum.2023.3541.