Opioid Prescribing Practices and Patient-Requested Refill Patterns after Laparoscopic Inguinal Hernia Repair

INTRODUCTION: Surgeons are often concerned that decreased opioid prescribing after operation will increase patient-requested refills. We investigated the rate of patient-requested opioid refills and associated factors after laparoscopic inguinal hernia repair (LIHR). METHODS: LIHRs at a single institution from March 2019 to March 2021 were queried from the Abdominal Core Health Quality Collaborative for demographics, perioperative details, and patient-reported opioid usage. Opioid prescriptions at discharge and patient-requested opioid refills were extracted from the medical record. Univariate regression was used to find factors associated with opioid refills within 30 days of the index operation. RESULTS: For 490 LIHR patients, the median number of opioid tablets prescribed was 12 (interquartile range [IQR] 10 to 15), and 4% (20/490) requested a refill. Patients who requested refills were younger (55 years [IQR 37 to 61] vs 62 years [IQR 36.8 to 61], p = 0.012), more likely to have undergone transabdominal preperitoneal repair (75% vs 26.4 %, p < 0.001), more likely to have had a scrotal component (30% vs 11%, p = 0.022), and more likely to have had permanent tacks used (80% vs 49.4%, p = 0.014). Patients who requested refills were not prescribed statistically different morphine equivalents at discharge compared with those who did not request refills (112 mg [IQR 73.1 to 122] vs 75 mg [IQR 67.5 to 112], p = 0.143). Patient-reported opioid use was available for 289 (59%) patients. Postoperatively, 67% of patients used ≤4 opioid tablets, and 87% used no more than 10 opioid tablets. CONCLUSION: Most patients use fewer opioid tablets than they are prescribed. Requests for opioid refills are rare after LIHR (4%) and are not associated with lower opioid prescribing.