Evaluating discharge opioid prescribing practices in elective surgical patients: a retrospective audit from a tertiary surgical and rehabilitation centre

Objectives This study aimed to audit opioid prescribing practices at hospital discharge for elective surgical patients and assess alignment with contemporary best-practice recommendations. Methods A retrospective audit of adult elective surgical inpatients at a tertiary surgical and rehabilitation centre (1 October 2024–1 January 2025) examined discharge opioid prescribing, in oral morphine equivalent daily dose (oMEDD), against inpatient opioid use. A supplementary theatre register was used to compare patients discharged with and without an opioid. Results Of 580 patients screened, 576 were eligible; 47.6% (n = 274) were discharged with an opioid, most often oxycodone IR (54.8%) or tapentadol (41.2%), typically as a fixed quantity of 10 (52.2%) or five (27.4%) tablets. Discharge oMEDD (median 75 mg, interquartile range (IQR) 75–150) correlated moderately with inpatient oMEDD in the preceding 24 h (r = 0.57, P < 0.001); the estimated days-equivalent supply (median 3.1 days) matched recommended 3–5 day courses for most patients, though 13.8% received an opioid despite no recent inpatient use. Opioid recipients were significantly younger (48 vs 65 years, P < 0.001) and concentrated in higher-pain specialties such as orthopaedics, whereas opioids were rarely prescribed after ophthalmology; length of stay did not differ between groups. Only 17.8% of patients discharged with an opioid also received simple analgesia at discharge. Conclusions Discharge opioid prescribing was reasonably individualised by patient and procedure, but quantity was frequently standardised rather than tailored, and a minority of patients received an opioid despite no recent inpatient need. Strengthening quantity individualisation, discharge simple analgesia, and patient education around cessation would further align prescribing with opioid stewardship principles.