EP529 - The Balance Between Post-Operative Opioid Prescriptions and Under-Prescribing

Sunday, May 11, 2025

3:03 PM – 3:08 PM PT

Location: Monitor 9, Sails Pavilion, Upper Level

ePoster Presenter(s)

NC

Nathan Coppersmith, MD (he/him/his)

Resident Physician
Yale School of Medicine
New Haven, CT, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Author(s)

JG

Jeannette Garcia Coppersmith, EdM

Graduate Student
Harvard Graduate School of Education
Hamden, Connecticut, United States

Disclosure information not submitted.
Andrew C. Esposito, MD MHS (he/him/his)

General Surgery Resident
Yale-New Haven Hospital
New Haven, CT, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
Ira L. Leeds, MD

Asst Prof of Surgery
Yale School of Medicine
New Haven, Connecticut, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no relevant relationships with ineligible companies.
Haddon J. Pantel, MD

Assistant Professor
Yale University
New Haven, Connecticut, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no relevant relationships with ineligible companies.
VR

Vikram B. Reddy, MD, PhD, MBA

Chief of Colon and Rectal Surgery
Yale University School of Medicine
New Haven, Connecticut, United States

Disclosure information not submitted.
Anne K. Mongiu, MD, PhD

Assistant professor, colon and rectal surgery
Yale university school of medicine, Yale New Haven Hospital
new haven, Connecticut, United States

Disclosure information not submitted.

Senior Author(s)

PY

Peter Yoo, MD

Associate Chief of Academic Affairs
Hartford Healthcare Corporation
Hartford, Connecticut, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.

Nathan Coppersmith, MD: This individual has no financial relationships with ineligible companies.

Andrew C. Esposito, MD MHS: This individual has no financial relationships with ineligible companies.

Ira L. Leeds, MD: This individual has no relevant relationships with ineligible companies.

Haddon J. Pantel, MD: This individual has no relevant relationships with ineligible companies.

Peter Yoo, MD: This individual has no financial relationships with ineligible companies.

Image or Table (Do Not add text here):

Purpose/Background: Prior research has established that modifications in the default electronic pill quantity for opioid prescriptions influence clinician prescribing practices. However, the field lacks evidence for the lowest threshold for reducing the default pill count before opioids are under-prescribed. To this end, system-wide efforts led to a decrease in the default opioid pill count by 33% from 12 to 8 pills at a large multi-hospital healthcare system in January 2023.

Methods/Interventions: We conducted a retrospective electronic medical review (EMR) in a large healthcare system comprised of seven affiliated hospitals. Our sample includes patients who 1) underwent a surgical procedure between October 2022 to April 2023, 2) were prescribed an opioid on discharge, and 3) were discharged on post-operative day 0 or 1. For three months before and after the default policy change, we collected data from the EMR on patient information, procedure, morphine milligram equivalents (MME) prescribed, and refills within 30 days. We conducted t-tests to compare differences in MME and refill rate before and after the policy change in addition to multiple regression analysis. We also examine differences by patient gender and race.

Results/Outcomes: We evaluated 10,709 unique surgeries to find the average MME of opioids prescribed on discharge significantly decreased from 101.2 MME to 96.2 MME after the change (p < 0.001) while the refill rate significantly increased from 23.2% to 25.5% (p=0.006). Out of 109 hemorrhoidectomies, there was no significant change in prescription quantity change (290.2 vs. 291.2 MME, p=0.89) and no patients requested a refill. Before and after the policy, average MME for White patients was significantly higher compared to non-White patients (102.3 vs 91.6, p< 0.001), while their refill rate was significantly lower (23.4% vs 26.1%, p=0.001). Further, average MME for female patients overall was significantly lower compared to male patients (94.1 MME vs 105.1 MME, p< 0.001), while their refill rate was significantly higher (27.5% vs 19.9%, (p < 0.001).

Conclusion/Discussion: The decrease in average MME prescribed as a result of the policy change translates to the difference between 13.5 and 12.8 oxycodone 5 mg pills per prescription, saving approximately 6,000 additional pills from being prescribed over the three months. However, the 2% increase in refill rate suggests some patients were under-prescribed post-operative pain medication as a result of the policy change. Our findings also show non-White and female patients were systematically under-prescribed post-operative pain medication before and after the policy change, suggesting opportunities to improve prescription policies. Our findings have implications for efforts to reduce opioids in the community while ensuring patients receive adequate and equitable post-operative pain control.