An updated analysis of discharge opioid-prescribing patterns across surgical specialties in the USA.

BACKGROUND

Opioid overdose still accounts for substantial deaths and hospitalizations in the United States. Opioids continue to be commonly prescribed for postoperative pain. Although variation in postoperative opioid prescribing has been previously described, contemporary national data using newly available discharge-prescribing variables may provide useful benchmarks across surgical specialties and procedures. We sought to describe current patterns of opioid prescribing at discharge across surgical specialties and high-volume procedures in the United States.

METHODS

This cross-sectional analysis used the 2024 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database and included adults undergoing selected procedures in the United States. The primary outcomes were the receipt of an opioid prescription at discharge and quantify the daily discharge opioid dose, expressed as morphine milligram equivalents per day (MME/day).

RESULTS

Among 757,548 selected surgical procedures (mean [SD] age of patients, 56.35 [16.97] years; 441,799 [58.32%] female patients), 565,959 patients (74.71%) received an opioid prescription at discharge. Median daily opioid doses ranged from 30 to 45 MME/day across surgical specialties, and 4.1% of patients received a refill. Adjusted probabilities of receiving an opioid prescription at discharge varied by specialty: from 54.1% (95% CI 52.0%-55.9%) in cardiac surgery and 60.0% (95% CI 59.2%-60.7%) in vascular surgery to 84.3% (95% CI 84.1-84.5%) in orthopedics and 85.3% (95% CI, 84.7-85.9%) in thoracic surgery. Laparoscopic hernia repair, knee arthroplasty, hip arthroplasty, spine fusion, and laminectomy/corpectomy each had an adjusted probability of opioid prescription at discharge that exceeded 83%.

CONCLUSIONS AND RELEVANCE: This study provides an updated descriptive benchmark of postoperative opioid-prescribing patterns across surgical specialties and selected high-volume procedures. This evidence offers a foundation for strategic actions to reduce variation and improve patient care.