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Original Investigation
January 16, 2019

Association of Opioid Prescribing With Opioid Consumption After Surgery in Michigan

Author Affiliations
  • 1Department of Surgery, University of Michigan, Ann Arbor
  • 2Michigan Opioid Prescribing Engagement Network, Ann Arbor
  • 3University of Michigan School of Medicine, Ann Arbor
  • 4Michigan Surgical Quality Collaborative, Ann Arbor
  • 5Department of Anesthesiology, University of Michigan, Ann Arbor
JAMA Surg. 2019;154(1):e184234. doi:10.1001/jamasurg.2018.4234
Key Points

Question  What factors are associated with opioid consumption after surgery?

Findings  In this population-based study of patients undergoing surgery in Michigan, 2392 patients used only 27% of the opioids prescribed to them. Prescription size had the strongest association with opioid consumption after surgery, with patients using an additional 5 pills for every 10 extra pills prescribed.

Meaning  Excessive opioid prescribing is associated with higher opioid consumption after surgery. Using patient-reported opioid consumption will improve postoperative opioid prescribing to better match patient opioid requirements.


Importance  There is growing evidence that opioids are overprescribed following surgery. Improving prescribing requires understanding factors associated with opioid consumption.

Objective  To describe opioid prescribing and consumption for a variety of surgical procedures and determine factors associated with opioid consumption after surgery.

Design, Setting, and Participants  A retrospective, population-based analysis of the quantity of opioids prescribed and patient-reported opioid consumption across 33 health systems in Michigan, using a sample of adults 18 years and older undergoing surgery. Patients were included if they were prescribed an opioid after surgery. Surgical procedures took place between January 1, 2017, and September 30, 2017, and were included if they were performed in at least 25 patients.

Exposures  Opioid prescription size in the initial postoperative prescription.

Main Outcomes and Measures  Patient-reported opioid consumption in oral morphine equivalents. Linear regression analysis was used to calculate risk-adjusted opioid consumption with robust standard errors.

Results  In this study, 2392 patients (mean age, 55 years; 1353 women [57%]) underwent 1 of 12 surgical procedures. Overall, the quantity of opioid prescribed was significantly higher than patient-reported opioid consumption (median, 30 pills; IQR, 27-45 pills of hydrocodone/acetaminophen, 5/325 mg, vs 9 pills; IQR, 1-25 pills; P < .001). The quantity of opioid prescribed had the strongest association with patient-reported opioid consumption, with patients using 0.53 more pills (95% CI, 0.40-0.65; P < .001) for every additional pill prescribed. Patient-reported pain in the week after surgery was also significantly associated with consumption but not as strongly as prescription size. Compared with patients reporting no pain, patients used a mean (SD) 9 (1) more pills if they reported moderate pain and 16 (2) more pills if they reported severe pain (P < .001). Other significant risk factors included history of tobacco use, American Society of Anesthesiologists class, age, procedure type, and inpatient surgery status. After adjusting for these risk factors, patients in the lowest quintile of opioid prescribing had significantly lower mean (SD) opioid consumption compared with those in the highest quintile (5 [2] pills vs 37 [3] pills; P < .001).

Conclusions and Relevance  The quantity of opioid prescribed is associated with higher patient-reported opioid consumption. Using patient-reported opioid consumption to develop better prescribing practices is an important step in combating the opioid epidemic.

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