Prescriptions For Common Vascular General Surgical Procedures
Opioid overdose is now the leading cause of injury related death in the United States, having surpassed motor vehicle accidents for the first time. It is estimated that deaths secondary to prescription opioid overdose have quadrupled in the past 15 years, and now reach almost 19,000 per year. An essay writer is a person whose job is to create articles related to surgical content as well.
One potential driver of this mortality is that there has been a dramatic rise in the rate of opioid prescribing in the United States over the past decade. In 2012, 82.5 opioid prescriptions were written per 100 persons; which has quadrupled since 1999. This amount is estimated to supply every adult American with 5 mg of hydrocodone every 6 hours for 45 days. Some suggest that the increase in opioid prescribing practice is due in part to the identification of pain as a “fifth vital sign” following the institution of rigorous pain assessment standards by the Joint Commission on Accreditation of Healthcare Organizations in 2001 and the curtailing of restrictions that previously limited opioid prescriptions to treat cancer related pain only. The writer assigned to write essay for me task of surgical content is qualified to the same academic level or higher than your writing requirements.
The availability of prescription opioids has resulted in their widespread abuse. Over 5 million Americans report that they currently (within 30 days) abuse prescription opioids and 10.3 million have abused them at some point in their lifetime. It has been noted that although most of these pills originated from a licensed prescriber, only 20% of users were the legitimate recipient of the initial prescription, with 71% of users having received the drug through methods of diversion. In addition, it is reported that 55% of these people received pills for free from a family member or friends who had excess pills. Parallel to the rise in prescription opioid use, the rate of heroin use has been rising. This is of concern because 50% to 85% of heroin users began by abusing prescription opioids first.
In recognition of this deadly problem, both state and federal legislation has been introduced to attempt to control access to prescription opioids and to increase funding for prevention of abuse. In 2014, the Federal Drug Enforcement Agency (DEA) rescheduled hydrocodone combination products from schedule III to schedule II controlled substances, effectively eliminating the ability to authorize refills or to call or fax in prescriptions to pharmacies. This change requires patients to return to clinic to receive additional opioids. As of March 2016, there are now over 375 proposals in state legislatures that aim to regulate several aspects of prescribing practices for opioid analgesics in attempts to decrease excess pills.
A bill in Massachusetts passed in March that restricts prescription opioids to a 7-day supply for acute pain. In addition, the Center for Disease Control (CDC) recently issued guidelines for primary care physicians treating chronic pain with opioids; however, these guidelines provided little information on recommendations for acute pain. The guideline states that because chronic pain treatment begins with acute pain treatment, physicians should limit initial opioid prescriptions by prescribing “no greater quantity than needed.” The FDA has stated that “until clinicians stop prescribing opioids far in excess of clinical need, this crisis will continue unabated.” The writer assigned to write my essay request about surgical content is qualified to the same academic level or higher than your writing requirements.
The task of decreasing excess opioid prescriptions has been left in the hand of the provider. Providers both have the societal imperative to avoid overprescribing and the obligation to ensure their patients postoperative pain is addressed. Although broad guidelines for treating postoperative pain have been formulated, there are no clear operation-specific guidelines for opioid prescriptions for general surgical procedures. A few studies exist that address optimal postoperative opioid prescriptions in urologic, oral, hand, and outpatient upper extremity surgery. Given the lack of information on ideal prescribing practices for general surgery cases, we evaluated the variation in current opioid prescribing practices and sought to estimate a reasonable number of pills to prescribe for common outpatient general surgery procedures.
METHODS
We evaluated the 5 most common outpatient general surgery procedures performed at our academic medical center in 2015. These were partial mastectomy, partial mastectomy with sentinel lymph node biopsy, laparoscopic cholecystectomy, laparoscopic inguinal hernia repair, and open inguinal hernia repair.
Postoperative opioid prescriptions entered into the electronic medical record (EMR), refill data, and patient outcomes were tabulated. Only opioid naïve patients, defined as having no history of opioid use within the 30 days prior to their procedure, were included in this analysis. Patients with a history of opioid abuse and those with postoperative complications (which might be painful and require additional opioids) were also excluded.
As patients were prescribed a variety of different opioid formulations, we converted the number of pills prescribed to an equianlagesic equivalent. One pill was considered to be the analgesic equivalent of 5 mg of oxycodone.
A phone survey was then attempted on all patients who were operated on from June through December 2015 and also received an opioid prescription (n=330). One hundred forty seven patients were contacted. Patients were queried on how much of their prescribed opioid was taken and whether they required a refill. Twenty patients were not able to recall the amount of opioid they took. Patients who did recall their usage were assigned “% taken” estimations. Those who reported no opioid use were assigned “0% pills taken,” those who reported 1% to 49% used were assigned “25% taken,” those reporting 50% to 99% used were assigned “75% taken,” and those who reported all pills used were assigned “100% taken.”
The Dartmouth Committee for the Protection of Human Subjects approved this project and determined that individual patient consent was not required. An essay typer is a person whose job is to create articles related to surgical content as well.
RESULTS
In 2015, 183 partial mastectomies, 112 partial mastectomies with sentinel node biopsy, 240 laparoscopic cholecystectomies, 80 laparoscopic inguinal hernia repairs, and 85 open inguinal hernia repairs were performed. Thirty eight (5.4%) patients were excluded for recent opioid use or abuse and 18 (2.6%) for postoperative complications (9 hematomas requiring evacuation, 2 wound dehiscence, 2 retained gallstones, 1 bile leak, 1 seroma requiring drainage, 2 urinary retention, and 1 diarrhea requiring admission). Six hundred forty two cases underwent further analysis.