Opioid-free discharge after hepatopancreatobiliary surgery: Patterns, predictors, and opportunities for stewardship.

INTRODUCTION

Postoperative opioid prescriptions may represent an initial source of opioid exposure, yet discharge prescribing patterns after hepatopancreatobiliary (HPB) surgery remain poorly defined.

METHODS

We analyzed the 2024 ACS-NSQIP database to identify adults undergoing liver or pancreatic resection and evaluated opioid prescription at discharge, opioid-free discharge, and prescribed morphine milligram equivalents (MME) by procedure, operative approach, and local or regional anesthesia use.

RESULTS

Among 11169 patients, only 2328 (20.8%) were discharged opioid-free. Opioid-free discharge varied by procedure and was more common after minimally invasive surgery. In contrast, among patients prescribed opioids, dosing was relatively uniform across procedures and approaches, with most prescriptions ≤50 MME. Local or regional anesthesia did not translate into higher opioid-free discharge and was associated with slightly higher adjusted MME.

CONCLUSION

These findings suggest that HPB discharge prescribing is driven more by the decision to prescribe than by dose selection, supporting procedure-specific opioid-sparing discharge pathways.