OBJECTIVES: Patients undergoing surgery are often discharged with an opioid prescription. Overprescribing opioids can lead to increase opioid-related adverse effects, addiction and overdose. The objective of this study was to determine if there is an association between the length of surgery and potentially overprescribed opioids.

METHODS: Data for the study was collected from the electronic health records of patients who had an inpatient stay of at least 24 hours between January 1, 2018 and December 31, 2019 during which surgery was performed at an academic medical center in the southern United States. Patients were included if they were administered an opioid within 24-hour before discharge or were prescribed an opioid at discharge. The outcome variable was potential opioid overprescribing defined as receiving a morphine equivalent daily dose (MEDD) at discharge greater than the MEDD administered during the 24 hours before discharge. The primary exposure of interest was the length of surgery. Multivariable logistic regression was used to assess the association between the length of surgery and potential opioid overprescribing.

RESULTS: There were 4,525 patients included in the study. Of these patients, 1,379 (30.48%) had been discharged on MEDD greater than the previously administered 24-hour MEDD. After adjusting for other covariates, the risk of potential opioid overprescribing increased as the surgery lasted longer (AOR=1.087; 95%CI:1.037-1.140). Older patients (AOR=1.008; 95%CI:1.004-1.013) and patients who experienced lower average inpatient pain scores (AOR=0.797; 95%CI:0.765-0.831) had a significantly higher risk of opioid overprescribing.

CONCLUSIONS: Our findings suggest the dose of opioids administered in the 24 hours before discharge may not be sufficiently considered when prescribing opioids at discharge. Factors such as duration of the procedure, age, and average pain score can influence this prescribing decision. Making information on opioid administration easily accessible to prescribers could increase the reliance on this measure for prescribing.