Opioid Prescriptions after Hemorrhoidectomy

Pamela W. Lu*, Adam C. Fields, Tomas Andriotti, Vanessa M. Welten, Mehida Rojas-Alexandre, Tracey P. Koehlmoos, Andrew J. Schoenfeld, Nelya Melnitchouk

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

15 Scopus citations

Abstract

BACKGROUND: Hemorrhoids cause more than 4 million ambulatory care visits in the United States annually, and hemorrhoidectomy is associated with significant postoperative pain. There are currently no evidence-based opioid-prescribing guidelines for hemorrhoidectomy patients. OBJECTIVE: The purpose of this study was to investigate patterns of opioid prescribing and to identify factors associated with opioid refill after hemorrhoidectomy. DESIGN: This was a retrospective database review. SETTINGS: The study was conducted using the Department of Defense Military Health System Data Repository (2006-2014). PATIENTS: Opioid-naïve patients aged 18 to 64 years enrolled in TRICARE insurance who underwent surgical hemorrhoidectomy were included in this study. MAIN OUTCOME MEASURES: We measured patterns of opioid prescriptions and predictors of a second opioid prescription within 2 weeks of the end date for the first prescription after hemorrhoidectomy. RESULTS: A total of 6294 patients were included; 5536 (88.0%) filled an initial opioid prescription with a median 5-day supply, and 1820 (32.9%) required an opioid refill. The modeled risk of refill based on initial prescription supply ranged from a high of 39.2% risk with an initial prescription of 1-day supply to an early nadir (26.1% risk of refill) with an initial 10-day supply. A variety of sociodemographic and clinical characteristics influenced the likelihood of opioid refill, including black race (OR = 0.75 (95% CI, 0.62-0.89)), history of substance abuse (OR = 3.26 (95% CI, 1.37-7.34)), and length of index opioid prescription (4-6 d, OR = 0.83 (95% CI, 0.72-0.96) or ≥7 d, OR = 0.67 (95% CI, 0.57-0.78) vs 1-3 d). LIMITATIONS: Variables assessed were limited because of the use of claims-based data. CONCLUSIONS: There is wide variability in the length of prescription opioid use after hemorrhoidectomy. Approximately one third of patients require a second prescription in the immediate postoperative period. The optimal duration appears to be between a 5- and 10-day supply. Clinicians may be able to more efficiently discharge patients with adequate analgesia while minimizing the potential for excess supply.

Original languageEnglish
Pages (from-to)1118-1126
Number of pages9
JournalDiseases of the Colon and Rectum
Volume63
Issue number8
DOIs
StatePublished - 1 Aug 2020
Externally publishedYes

Keywords

  • Hemorrhoid
  • Hemorrhoidectomy
  • Narcotics
  • Opioids
  • Postoperative

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