Society For Clinical Vascular Surgery

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Exploring Patient Needs and Provider Perceptions of Opioid Prescribing Following CEA
Brian P. Cleary, BS, Peris R. Castaneda, MA, Anna N. Berezovsky, BS, Brooklyn Fillinger, BS, Dawn M. Coleman, MD, Nichoas H. Osborne, MD.
University of Michigan Medical School, Ann Arbor, MI, USA.

OBJECTIVES: The evolving opioid epidemic has led to increased attention to the prescribing practices of healthcare providers. Surgeons provide nearly 40% of all opioid prescriptions nationally. There is little data regarding the opioid prescribing patterns for patients following vascular surgery procedures. We examined vascular surgery provider prescribing patterns following carotid endarterectomy (CEA) and patient opioid use to assess for discrepancy. METHODS: A retrospective chart review examining CEA patients performed at the University of Michigan between May 2016 and June 2017. Patient characteristics, comorbidities, and risk factors for chronic pain were collected. Postoperative prescriptions for pain management at discharge were queried. Prescription filling data were collected using a tri-state database of all filled prescriptions of narcotics (MI-MAPS) to determine use. Bivariate statistics were used to examine factors associated with opioid prescription filling. A provider survey was administered to vascular surgery providers to examine attitudes and factors influencing opioid prescribing.
RESULTS: Seventy patients underwent a total of 72 CEAs, of which 43 (61.4%) were male and 27 (38.6%) were female. Mean age was 68.3 (9.4). Mean length of stay was 1.5 days (1.4). 56 patients were current or former smokers (80.0%), 44 reported alcohol use (62.9%) and 2 reported drug use (2.9%). 47 patients (67.1%) had prior diagnosis of a predisposing factor to pain: chronic pain syndrome (9), depression (14), and anxiety (24). Mean oral morphine equivalents for patients who filled their prescriptions were 200.6mg (140.1) (median = 150mg). Of the 54 CEA patients who were prescribed opioids, only 37 (68.5%) filled their opioid prescription. 18 of 24 vascular surgery providers completed the provider survey (75% response rate), including 8 attendings, 5 trainees, and 5 physician extenders. Notably, 12 of 18 of providers (66.7%) endorsed that their opioid prescribing habits are influenced by observing other practitioners. Moreover, most providers (89%) do not believe they overprescribe opioids to patients.
CONCLUSIONS: Prescribing patterns for common vascular surgery procedures vary significantly in both opioid type and quantity. Despite this wide variation in prescribing and filling, most providers do not believe they overprescribe. Following CEA, nearly one third of patients did not fill their opioid prescription. Further research is clearly needed to guide ‘best-prescription practices’ based on the actual pain needs of patients following CEA and other common vascular surgery procedures.

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