ASCRS Annual Scientific Meeting

Postoperative Opioid Prescribing: Effects of Lower Default Quantities on Refill Patterns

Anthony Calabro, MA

Key Highlights

  • Reducing the default opioid pill quantity from 12 to eight lowered the average morphine milligram equivalents (MME) prescribed.
  • Refill rates increased by 2.3% post-policy change, suggesting some underprescription of postoperative pain medication.
  • Non-White patients and women received lower average MMEs and had higher refill rates compared with White patients and men.

A system-wide policy reducing the default opioid pill count from 12 to eight significantly decreased the average MME prescribed at discharge following surgery, according to the authors of a retrospective electronic medical review presented at the American Society of Colon & Rectal Surgeons Annual Scientific Meeting in San Diego, CA. However, the policy was associated with a modest but statistically significant increase in the rate of opioid refills, suggesting that some patients may have been underprescribed.

Prior research has shown that default prescription quantities influence prescribing behavior, but the lowest safe threshold remains unclear. To address this gap, a large multi-hospital healthcare system implemented a 33% reduction in the default opioid pill count in January 2023, providing a unique opportunity to assess its effects on prescribing patterns and postoperative patient needs.

Researchers performed a retrospective electronic medical record review across seven affiliated hospitals, including adult patients who underwent surgery, were discharged on postoperative day 0 or 1, and were prescribed opioids from October 2022 to April 2023. Data collected included procedure details, patient demographics, opioid prescription MME, and refill rates within 30 days post-discharge. Statistical analysis involved t-tests and multiple regression, with subgroup analyses by gender and race.

bar graph

Among 10,709 surgeries evaluated, the average prescribed MME decreased from 101.2 to 96.2 after the policy change (P < .001), while the overall refill rate increased from 23.2% to 25.5% (P = .006). In hemorrhoidectomy cases, there was no significant change in prescription quantity or refill rates. White patients consistently received higher MMEs than non-White patients (102.3 vs 91.6; P < .001) and had lower refill rates (23.4% vs 26.1%; P = .001). Similarly, female patients received lower MMEs compared to male patients (94.1 vs 105.1; P = .001) but had higher refill rates (27.5% vs 19.9%; P = .001).

"The decrease in average MME prescribed as a result of the policy change translates to the difference between 13.5 and 12.8 oxycodone 5 mg pills per prescription, saving approximately 6000 additional pills from being prescribed over the 3 months," the authors concluded.

Reference
Coppersmith N, Esposito AC, Leeds IL, Pantel HJ, Yoo P. The balance between post-operative opioid prescriptions and under-prescribing. Presented at: 2025 American Society of Colon and Rectal Surgeons Annual Meeting; 2025; San Diego, CA. Available at: https://ascrs25.eventscribe.net/agenda.asp?pfp=ePosters. Accessed April 25, 2025.