Post-operative opioid consumption in Thoracic Surgery Patients: How much is actually used?

Abstract Background The object of this initiative was to perform a prospective, multi-center survey of patients following lung resection to assess the amount of opioids consumed and disposition of unused opioids to inform the development of evidence-based prescribing guidelines. Methods Adults undergoing lung resection via minimally invasive (MIS, n=108) or thoracotomy (n=45) were identified prospectively from three academic centers (3/2017 - 1/2018) to complete a 28-question telephone survey 21-35 days post-discharge. Discharge opioids were converted into Morphine Milligram Equivalents (MME) and compared across patient and surgical details. Results Of the 153 patients who completed the survey, 89.5% (137) received opioids at discharge with median prescription of 320 [IQR 225, 450] MME following MIS and 450 [IQR 300, 600] following thoracotomy, p=0.001. Median opioid consumption varied by surgical approach: 90 [IQR 0, 262.5] following MIS and 300 [50, 382.5] following thoracotomy, p Conclusions While patients undergoing MIS lung resection used significantly less opioids over a shorter duration of time than those following thoracotomy, they had relatively more excess opioid prescription. Development of evidence-based, procedure-specific guidelines with tailored pain regimens should be implemented to reduce the amount of post-operative opioids remaining in the community.