Opioid Prescribing by Plastic Surgery Residents: Higher Doses in US Compared to Canada

Plastic surgery trainees in the United States prescribe higher doses of opioids than their counterparts in Canada, suggests a study in the July issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

Even with education in opioid prescribing, few plastic surgery residents routinely provide patient counseling about pain medications, according to the new research by Hollie Power, MD, of University of Alberta, Edmonton, and colleagues. They write, "The current opioid-prescriber education that plastic surgery trainees receive is not standardized and is likely insufficient."

Call for Standardized Training to Reduce Opioid Overprescribing

The researchers surveyed 162 plastic surgery residents – 85 in the United States and 77 in Canada – regarding their prescribing of opioid pain relievers after eight common plastic surgery procedures. Residents are the main prescribers of opioids at teaching hospitals, yet there is little information on factors affecting their prescribing practice. The survey response rate was 32 percent.

Only about one-fourth of US plastic surgery residents said they had received opioid-prescriber education, compared to more than half of Canadian trainees. However, in both groups, only a small percentage of residents routinely screened for risk factors of opioid abuse or performed opioid counseling before surgery.

For seven out of eight procedures, US trainees prescribed significantly higher opioid doses than Canadian trainees. For example, for one type of breast reconstruction (DIEP flap), US plastic surgery residents prescribed nearly double the dose of opioids, compared to those in Canada.

The higher rate of opioid prescribing by US trainees remained significant after adjustment for other factors. Junior (less experienced) residents prescribed higher doses than senior residents.

The trainees cited a wide range of factors affecting their opioid prescribing – most commonly the expected level of postoperative pain and the preferences of the attending surgeon or senior resident. In both countries, few residents mentioned concerns about patient dissatisfaction.

Overprescribing after surgery is an important contributor to the opioid epidemic. The new research finds significant differences in opioid prescribing by plastic surgery residents in the United States and Canada, with US trainees prescribing higher doses for most procedures.

But the study finds room for improvement in both countries, including the use of screening and preoperative counseling about the addictive potential of opioids and recommended disposal of leftover medications. "Since surgical trainees are commonly the physicians most closely involved in postoperative discharge instructions, this represents an important opportunity to provide patients and their families with education on opioid safety," Dr. Power and coauthors write.

Standardized training to optimize opioid prescribing by surgical residents is essential, Dr. Power and colleagues believe. They conclude, "Ultimately, addressing the opioid epidemic in plastic surgery requires a multifaceted approach, of which trainee education is one component."

Note: The ASPS website provides information and resources on opioid prescribing, targeted to healthcare professionals.

Plastic and Reconstructive Surgery® is published by Wolters Kluwer.

Click here to read "Differences in Opioid Prescribing Practices among Plastic Surgery Trainees in the United States and Canada"

Article: "Differences in Opioid Prescribing Practices among Plastic Surgery Trainees in the United States and Canada" (doi: 10.1097/PRS.0000000000005780)