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Association of Limiting Opioid Prescriptions With Use of Opioids After Corneal Surgery

Educational Objective To quantify opioid use and to assess the association of decreasing the number of opioid tablets prescribed after corneal surgery with postsurgical use.
1 Credit CME
Key Points

Question  What is the association of decreasing the quantity of opioids prescribed after corneal surgery with opioid use and pain control?

Findings  In a cohort study of patients who underwent corneal surgery and for whom physicians decreased opioid prescribing, patients used less opioids yet had adequate (19 of 27 [70%]) or more-than-needed (6 of 27 [22%]) tablets for pain control. Most patients (20 of 28 [71%]) had unused opioid tablets, but none disposed of tablets properly.

Meaning  This study found that patients used fewer opioid tablets when surgeons prescribed fewer tablets, suggesting that physicians should evaluate opioid needs for their patients, decrease the number of tablets prescribed when possible, and encourage safe opioid storage and disposal to minimize dispersion to the community.

Abstract

Importance  Opioids, which carry a high risk for addiction and overdose, are commonly prescribed after corneal surgery. Data are lacking describing opioid prescribing practices and opioid needs by patients after ophthalmic surgery.

Objectives  To quantify opioid use and to assess the association of decreasing the number of opioid tablets prescribed after corneal surgery with postsurgical use.

Design, Setting, and Participants  This prospective cohort study investigated opioid use after corneal surgery using direct interviews of 2 adult patient cohorts separated by an updated opioid prescribing guideline. The first cohort survey assessed the quantity of opioid tablets used after surgery. The cornea division of a tertiary care academic medical center reviewed the use needs and decreased the number of tablets prescribed after routine cases. Simultaneously, a statewide opioid monitoring program began that provided patients with opioid information. A second unique cohort received a more detailed survey to assess use, opioid disposal, and pain control. Data for the first cohort were collected from December 1, 2017, through January 19, 2018; for the second cohort, from June 1 to September 15, 2018. Data were analyzed from October 24, 2018, through September 24, 2019.

Exposure  Corneal surgery.

Main Outcomes and Measures  Differences in use of opioid tablets used by both patient cohorts, assessed using the 2-sample t test.

Results  Of 112 eligible, contacted patients, 82 consented to participate (42 men [51%]; mean [SD] age, 42.5 [17.8] years) and were included in the analysis; 38 of 42 participated in the first cohort and 44 of 70 participated in the second cohort. Of those receiving opioid prescriptions, the first cohort was prescribed significantly more tablets than the second cohort (mean [SD], 18.8 [4.2] vs 6.6 [3.1]; difference, 12.2 [95% CI, 10.4-14.0]; P < .001). The first cohort used significantly more tablets than the second cohort (mean [SD], 8.3 [7.0] vs 4.0 [3.2]; difference, 4.3 [95% CI, 1.4-7.2]; P = .005) and had significantly more leftover tablets (mean [SD], 10.3 [6.9] vs 2.9 [2.7]; difference, 7.5 [95% CI, 4.7-10.2]; P < .001). In the detailed survey for the second cohort, 19 of 27 patients reported pain control as adequate (70% [95% CI, 50%-86%]); 6 of 27, as more than needed (22% [95% CI, 9%-42%]). Twenty of 28 participants (71% [95% CI, 55%-88%]) had leftover tablets; 17 of these (85% [95% CI, 62%-97%]) did not dispose of leftovers, and 3 (15% [95% CI, 3%-38%]) threw away or flushed leftovers.

Conclusions and Relevance  After an assessment of opioid needs, physicians prescribed fewer opioid pills. However, patients who underwent cornea surgery and received fewer tablets continued to have adequate pain control and used even fewer tablets compared with the initial cohort. Patients with unused opioid tablets did not dispose of them properly.

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Article Information

Accepted for Publication: September 15, 2019.

Corresponding Author: Maria A. Woodward, MD, MSc, W. K. Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, 1000 Wall St, Ann Arbor, MI 48105 (mariawoo@med.umich.edu).

Published Online: October 31, 2019. doi:10.1001/jamaophthalmol.2019.4432

Author Contributions: Dr Woodward and Ms Zhang are co–first authors. Dr Woodward had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Woodward, Behunin, Tannen, Waljee.

Acquisition, analysis, or interpretation of data: Woodward, Zhang, Behunin, Tannen, Niziol.

Drafting of the manuscript: Woodward, Zhang, Niziol, Waljee.

Critical revision of the manuscript for important intellectual content: Woodward, Behunin, Tannen, Niziol, Waljee.

Statistical analysis: Woodward, Niziol.

Administrative, technical, or material support: Woodward, Zhang, Behunin, Waljee.

Supervision: Woodward, Behunin, Tannen, Waljee.

Conflict of Interest Disclosures: Dr Woodward reported receiving support from the National Institutes of Health (NIH) during the conduct of this study, receiving a research grant unrelated to this research from Warby Parker, travel support as a medical director from Eversight, Ltd, and personal equity from Vortex Surgical. No other disclosures were reported.

Funding/Support: This study was supported by Clinical Scientist Award K23EY023596 from the NIH (Dr Woodward) and by grant F052165 from the Michigan Department of Health and Human Services (Dr Waljee).

Role of the Funder/Sponsor: The sponsors had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Contributions: Hamza Ashfaq, BA, School of Public Health, University of Michigan, helped format the manuscript for submission and external feedback. No compensation was received for this contribution.

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