Continuing Home Opioid Dose in Chronic Opioid Users Reduces Total Opioid Use after Ventral Hernia Repair

Introduction Managing acute postoperative pain in patients on chronic opioid therapy is challenging. There is little data regarding optimal perioperative chronic opioid management. We hypothesized that continuing the home dose of opioid while inpatient following ventral hernia repair (VHR) would reduce total opioid consumption postoperatively. Methods Chronic opioid users were ordered their home opioid scheduled and our standard multimodal analgesia regimen. At time of discharge, we reviewed inpatient opioid use and prescribed opioids based on morphine milligram equivalent (MME) consumed per our established protocol. Results VHR was performed in 658 patients with 117 utilizing chronic opioid medications from June 2017 through March 2022; 43 patients were managed on protocol and 74 were not. Inpatient daily MME consumption was similar between groups (34 vs 36 MME; p=0.285). Patients treated according to protocol received significantly lower MME prescriptions at discharge (80 vs 225 MME; p< 0.001) with similar refills (21.4 vs 25.4%; p=0.820). Conclusion Continuing home opioids for chronic opioid users following VHR resulted in less opioid prescribing with no increase in refills.