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Yibing Zhang, Nicholas Behunin, Leslie Niziol, Bradford Tannen, Maria A Woodward; Opioid Prescribing and Use after Corneal Surgeries. Invest. Ophthalmol. Vis. Sci. 2019;60(9):6482.
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© ARVO (1962-2015); The Authors (2016-present)
Ophthalmic surgeries often require postoperative pain medications, most commonly opioids, but data on use is limited. This study seeks to quantify opioid usage and patient satisfaction following corneal surgeries and assess the impact of a change in opioid prescribing.
We conducted a prospective study on prescribing and use of opioids for adults after corneal surgeries at the University of Michigan. After verbal consent, telephone interviews were performed to obtain the number of opioid tablets patients consumed postoperatively. Two interventions that changed prescribing policies occurred: (1) protocol change by the cornea division to decrease the number of opioid tablets prescribed and (2) institution of a prescription monitoring program mandated by the state of Michigan. Interviews were repeated with post-intervention patients to examine the effect of the policy changes. Opioid prescribing and usage were compared pre- and post-policy change with Fisher’s exact tests and 2-sample Wilcoxon tests.
82 patients (38 pre- and 44 post-interventions) were enrolled. Opioid pain medications were prescribed to 89.5% of the pre-policy change patients (n=34/38) and 70.4% of post-policy change patients (n=31/44; p=0.054). Of the patients receiving prescriptions, pre-intervention patients were prescribed a mean of 18.8 tablets (standard deviation, SD=4.2) versus 6.6 tablets (SD=3.1; p<0.0001) in the post-intervention group. Pre-intervention patients reported using a mean of 8.3 tablets (SD=7.0) versus 4.0 tablets (SD=3.2, p=0.018) in the post-intervention group. Of the 31 post-intervention patients who were prescribed opioid medications, 20 (64.5%) had leftover tablets; 17 (85%) did not dispose of the leftover and 3 (15%) threw away or flushed the leftovers. Of the post-intervention patients who filled their opioid prescriptions, 70.4% reported the number of opioid pills prescribed as adequate, 22.2% as more than needed, and 7.4% as less than needed for pain control. Only one patient sought outside management for pain control after surgery.
Many opioid tablets were prescribed following corneal surgery, leading to potential misuse and leftover medication. After decreasing prescribed opioid tablets after corneal surgeries, less opioids were used. However, some pills remained unused in patients’ homes. The majority of patients had adequate pain control despite lowering the number of initial opioid tablets prescribed.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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