<div class="section"> <a class="named-anchor" id="ab-soi170070-1"> <!-- named anchor --> </a> <h5 class="section-title" id="d7491308e367">Importance</h5> <p id="d7491308e369">The overprescription of pain medications has been implicated as a driver of the burgeoning opioid epidemic; however, few guidelines exist regarding the appropriateness of opioid pain medication prescriptions after surgery. </p> </div><div class="section"> <a class="named-anchor" id="ab-soi170070-2"> <!-- named anchor --> </a> <h5 class="section-title" id="d7491308e372">Objectives</h5> <p id="d7491308e374">To describe patterns of opioid pain medication prescriptions after common surgical procedures and determine the appropriateness of the prescription as indicated by the rate of refills. </p> </div><div class="section"> <a class="named-anchor" id="ab-soi170070-3"> <!-- named anchor --> </a> <h5 class="section-title" id="d7491308e377">Design, Setting, and Participants</h5> <p id="d7491308e379">The Department of Defense Military Health System Data Repository was used to identify opioid-naive individuals 18 to 64 years of age who had undergone 1 of 8 common surgical procedures between January 1, 2005, and September 30, 2014. The adjusted risk of refilling an opioid prescription based on the number of days of initial prescription was modeled using a generalized additive model with spline smoothing. </p> </div><div class="section"> <a class="named-anchor" id="ab-soi170070-4"> <!-- named anchor --> </a> <h5 class="section-title" id="d7491308e382">Exposures</h5> <p id="d7491308e384">Length of initial prescription for opioid pain medication.</p> </div><div class="section"> <a class="named-anchor" id="ab-soi170070-5"> <!-- named anchor --> </a> <h5 class="section-title" id="d7491308e387">Main Outcomes and Measures</h5> <p id="d7491308e389">Need for an additional subsequent prescription for opioid pain medication, or a refill.</p> </div><div class="section"> <a class="named-anchor" id="ab-soi170070-6"> <!-- named anchor --> </a> <h5 class="section-title" id="d7491308e392">Results</h5> <p id="d7491308e394">Of the 215 140 individuals (107 588 women and 107 552 men; mean [SD] age, 40.1 [12.8] years) who underwent a procedure within the study time frame and received and filled at least 1 prescription for opioid pain medication within 14 days of their index procedure, 41 107 (19.1%) received at least 1 refill prescription. The median prescription lengths were 4 days (interquartile range [IQR], 3-5 days) for appendectomy and cholecystectomy, 5 days (IQR, 3-6 days) for inguinal hernia repair, 4 days (IQR, 3-5 days) for hysterectomy, 5 days (IQR, 3-6 days) for mastectomy, 5 days (IQR, 4-8 days) for anterior cruciate ligament repair and rotator cuff repair, and 7 days (IQR, 5-10 days) for discectomy. The early nadir in the probability of refill was at an initial prescription of 9 days for general surgery procedures (probability of refill, 10.7%), 13 days for women’s health procedures (probability of refill, 16.8%), and 15 days for musculoskeletal procedures (probability of refill, 32.5%). </p> </div><div class="section"> <a class="named-anchor" id="ab-soi170070-7"> <!-- named anchor --> </a> <h5 class="section-title" id="d7491308e397">Conclusions and Relevance</h5> <p id="d7491308e399">Ideally, opioid prescriptions after surgery should balance adequate pain management against the duration of treatment. In practice, the optimal length of opioid prescriptions lies between the observed median prescription length and the early nadir, or 4 to 9 days for general surgery procedures, 4 to 13 days for women’s health procedures, and 6 to 15 days for musculoskeletal procedures. </p> </div><p class="first" id="d7491308e402">This cohort study uses data from the Department of Defense Military Health System Data Repository to describe patterns of opioid pain medication prescriptions after common surgical procedures and determine the appropriateness of the prescription as indicated by the rate of refills. </p><div class="section"> <a class="named-anchor" id="ab-soi170070-8"> <!-- named anchor --> </a> <h5 class="section-title" id="d7491308e408">Question</h5> <p id="d7491308e410">What are the optimal ranges of initial durations of opioid prescriptions in a cohort of opioid-naive patients who have undergone common surgical procedures? </p> </div><div class="section"> <a class="named-anchor" id="ab-soi170070-9"> <!-- named anchor --> </a> <h5 class="section-title" id="d7491308e413">Findings</h5> <p id="d7491308e415">In this cohort study of 215 140 individuals, the median observed prescription lengths were 4 days for general surgery procedures, 4 days for women’s health procedures, and 6 days for musculoskeletal procedures. The prescription lengths associated with lowest requirement for refill were 9 days for general surgery, 13 days for women’s health, and 15 days for musculoskeletal procedures. </p> </div><div class="section"> <a class="named-anchor" id="ab-soi170070-10"> <!-- named anchor --> </a> <h5 class="section-title" id="d7491308e418">Meaning</h5> <p id="d7491308e420">The ideal initial prescription duration likely falls between the observed median and the modeled nadir in refill rate. </p> </div>