Opioids 7-fold more common in Americans vs Swedes after low-risk surgery

  • Ladha KS & al.
  • JAMA Netw Open
  • 04/09/2019

  • Kelli Whitlock Burton
  • Clinical Essentials
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Takeaway

  • More than 70% of opioid-naive patients in the United States and Canada filled opioid prescriptions within 7 days of undergoing 1 of 4 common low-risk surgical procedures compared with just 11% in Sweden.
  • The United States also had the highest average opioid prescription dose of all 3 countries.

Why this matters

  • Studies suggest that overprescribing opioids for short-term pain, such as after surgery, is widespread.

Study design

  • Opioid-naive patients who underwent surgery in the United States (n=129,379), Canada (n=84,653), and Sweden (n=9802) were identified.
  • Patients underwent laparoscopic cholecystectomy, laparoscopic appendectomy, arthroscopic knee meniscectomy, or breast excision.
  • Funding: NIH; Institute for Clinical Evaluative Sciences.

Key results

  • Within 7 days of discharge, the United States and Canada reported opioid prescription filing in 76.2% and 78.6% of patients, respectively.
  • Opioid prescription filing rate was significantly lower in Sweden within 7 days of discharge, at 11.1% (P<.001>
  • The mean morphine milligram equivalent was highest in the United States (n=247), followed by Canada (n=169) and Sweden (n=197).
  • Type of opioid use in Canada, Sweden, and the United States, respectively:
    • Codeine: 39.3%, 15.7%, and 3.3%.
    • Tramadol: 18.5%, 29.0%, and 3.5%.
    • Combination opioid formulations: 86.2%, 15.7%, and 90.7%.

Limitations

  • Retrospective study.
  • Information on postoperative pain experiences absent.

Coauthored with Chitra Ravi, MPharm