Best of the Best Gen Surg - Predictors of Low and High Opioid Tablet Consumption after Inguinal Hernia Repair – an ACHQC Opioid Reduction Task Force Analysis - Dr. Warren
With Dr. Jeremy Warren & Dr. Todd Ponsky · hosted by Dr. em gootee · Live Event Content
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Inguinal Hernia 28 items
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Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
More than 60 percent of inguinal hernia patients in a Greenville study required no opioid consumption
The ACHQC is a national hernia-specific registry containing over 100,000 patients
Over 80 percent of patients reported taking less than 10 pills after inguinal hernia repair
Over 50 percent of patients reported taking no opioids at all after inguinal hernia repair
Younger age, smokers, ASA 3 or 4, preoperative opioid use, open mesh repairs, longer operative times, and worse baseline quality of life increased the risk of high opioid consumption post-op
The study analyzed 1,937 patients undergoing elective, clean inguinal hernia repair with completed 30-day follow-up and complete opioid data
59 percent of cases were minimally invasive inguinal hernia repairs (lap and robotic), 35 percent open mesh repairs, and 6 percent open tissue repairs
Patients were at significantly higher risk of opioid consumption when prescribed a higher volume of pills
History of smoking increases the risk of opioid consumption after inguinal hernia repair
Patients reported consuming zero narcotics in 50 percent of cases, with only 8 percent reporting more than 10 tablets consumed
Patients with prior or recent opioid use are at higher risk of post-operative opioid consumption, supporting avoidance of prescribing opioids for hernia-related pain prior to surgery
Older age, ASA 1 or 2, use of local anesthetic, use of sedation versus general anesthetic, and shorter operative time all increased the chances that patients would use zero narcotics post-op
Minimally invasive approach and use of local anesthetic are surgeon-modifiable factors that reduce opioid consumption
Patient-reported opioid use is significantly impacted by surgeon prescribing
Patients with no opioid use prior to surgery or prescribed fewer than seven pills were the most likely to consume zero narcotics post-operatively
Almost every state has reversed legislation to allow prescribing limited opioids without hand-off through EMRs
A surgeon previously discharged every inguinal hernia patient with 50 oxycodones at $3 prescription cost plus $23 FedEx for refills
For laparoscopic inguinal hernias, a surgeon has discharged patients with zero narcotics for six months, using ice and scheduled Motrin and Tylenol, with only one refill request
Other specialties use drugs like gabapentin and Tylenol to achieve effective pain relief without narcotics
Over half a million opioid-related deaths occurred in the last 20 years
Prescription opioid-related deaths increased by 17% in the last year
Transition to synthetic opioids and heroin often begins with exposure to prescribed opioids
A 2017 Dartmouth study demonstrated wide range of surgeon prescribing patterns for common procedures and that patients typically consume dramatically less opioid than prescribed
Patients were prescribed between 15 and 120 opioid tablets after inguinal hernia repair, with an average of over 30 pills prescribed
Patients reported taking only 15 to 30 percent of prescribed tablets after inguinal hernia repair
The rate of refill calls for inguinal hernias following these guidelines is 4%
The number one predictor of how many opioid tablets a patient takes is how many they are prescribed