Winning by default: Tonsillectomy study shows power of pre-set opioid Rx size

A small tweak to hospitals’ prescribing systems might make a big difference in reducing risk from leftover opioid pain medication, while still making sure surgery patients get relief from their post-operation pain, a new study suggests.

In teens and young adults having their tonsils taken out at a major children’s hospital, patients went home with 29% fewer doses of opioid painkillers, but reported similar pain control, after researchers reduced the default opioid prescription size that doctors saw in their ordering system. Leftover doses raise the risk of long-term opioid use and the potential for misuse.

Meanwhile, prescription sizes remained high in a comparison group of young adults who had their tonsils out during the same time in nearby surgical centers that didn’t change the default prescription size. The study, from a team at Michigan Medicine, the University of Michigan’s academic medical center, is published in JAMA Network Open.

The new default prescription size — 12 doses — at U-M Health C.S. Mott Children’s Hospital was based on a survey on how many opioid doses young patients actually take for tonsillectomy pain. It replaced the previous default size of 30 doses, though doctors were always free to prescribe more or less.

After the default changed in October 2020, the percentage of patients who left the hospital with 12 doses went from 1% to 44%, the average prescription size went from 22 to 16 doses, and there was no significant change in pain control satisfaction scores or the number of prescription refills within two weeks of the operation.

Meanwhile, young adults who had their tonsils out at U-M’s University Hospital or other U-M Health surgical centers during the same time saw little change in prescribing. They received around 30 doses of opioids on average.

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