Tang R, Santosa KB, Vu JV, et al. Preoperative Opioid Use and Readmissions Following Surgery [published online ahead of print, 2020 Mar 13]. Ann Surg. 2020;10.1097/SLA.0000000000003827. doi:10.1097/SLA.0000000000003827
- Among the Medicare patient population who undergo elective surgery, 55% were opioid naïve while the remaining 45% filled one or more opioid prescriptions in the 12 months before surgery.
- Patients were grouped into five levels of preoperative opioid exposure – naïve, minimal, low, moderate, and high/chronic.
- Higher levels of preoperative opioid exposure were associated with higher rates of opioid-related readmissions, pain-related readmissions, respiratory-related readmissions, and all-cause readmissions.
Finney FT, Gossett TD, Hu HM, et al. Rate of Opioid Prescriptions for Patients With Acute Ankle Sprain. Ann Intern Med. 2019;171(6):441-443. doi:10.7326/M19-0679
- Among opioid naïve patients who did not fill an opioid prescription one year before sprain diagnosis, 8.3% filled an opioid prescription within 7 days of diagnosis, and, in this group, the rate of new, persistent opioid use (filled an opioid prescription 91 to 180 days after diagnosis and initial opioid exposure) was 8.4%.
- The most commonly prescribed opioid was hydrocodone (62.3%), followed by tramadol (15.6%) and oxycodone (11.5%).
- Most prescriptions were provided by physicians (77.4%) and advanced practice providers (18.9%) in emergency medicine and primary care settings.
Delaney LD, Gunaseelan V, Rieck H, Dupree JM 4th, Hallstrom BR, Waljee JF. High-Risk Prescribing Increases Rates of New Persistent Opioid Use in Total Hip Arthroplasty Patients [published online ahead of print, 2020 Apr 14]. J Arthroplasty. 2020;S0883-5403(20)30349-1. doi:10.1016/j.arth.2020.04.019
- Patients of surgeons with the highest rates of high-risk prescribing were more likely to develop persistent use compared with patients of surgeons with the lowest rates (adjusted rates: 9.7% vs 4.6%)
- Patients of surgeons with initial prescription sizes in the “high” (third) quartile and of surgeons in the “highest” (fourth) quartile of 30-day prescription dosage were more likely to develop persistent opioid use compared with patients of surgeons with low initial and 30-day prescription sizes, respectively.
- While the development of persistent opioid use after surgery is multifactorial, surgeon prescribing patterns play an important role.
- Reducing prescribing and encouraging opioid alternatives could minimize postoperative persistent opioid use.
Southren DL, Moser S, Abu-Amara H, et al. Opioid Fills for Lumbar Facet Radiofrequency Ablation Associated with New Persistent Opioid Use. Anesthesiology. 2020;132(5):1165-1174. doi:10.1097/ALN.0000000000003164
- 1% of patients undergoing lumbar facet radiofrequency ablation filled a perioperative opioid prescription, while 78.9% of patients did not have a perioperative opioid fill.
- The unadjusted rate of new persistent opioid use was 5.6% in the group with a perioperative opioid fill versus 2.8% for those without an opioid fill.
- Periprocedural opioid prescription fill was independently associated with increased odds of new persistent opioid use
- Opioid prescribing after radiofrequency ablation should be reevaluated and likely discontinued in this population.
Katzman C, Harker EC, Ahmed R, et al. The Association Between Preoperative Opioid Exposure and Prolonged Postoperative Use [published online ahead of print, 2020 May 18]. Ann Surg. 2020; doi:10.1097/SLA.0000000000003723
- 41% of patients had nonchronic, periodic opioid fills in the year prior to general, gynecologic, and urologic surgical procedures.
- Patterns of preoperative fills were most strongly associated with persistent postoperative opioid use. Patients with recent intermittent use were significantly more likely to have prolonged fills after surgery compared with opioid-naïve patients
- Identifying opioid use before surgery is a critical opportunity to optimize care after surgery.
Billig JI, Sears ED, Gunaseelan V, et al. Inappropriate Preoperative Gabapentinoid Use Among Patients With Carpal Tunnel Syndrome. J Hand Surg Am. 2020;45(8):677-689.e5. doi:10.1016/j.jhsa.2020.04.011
- 6% of patients are prescribed a gabapentinoid prior to surgery
- Of the patients with preoperative gabapentinoid use, 24% had prolonged gabapentinoid use and 20% of the preoperative gabapentinoid users also filled opioid prescriptions at 91 to 180 days after carpal tunnel release
- Given the effectiveness of surgical release and the risks associated with gabapentinoids, greater attention is needed to ensure that gabapentinoids are prescribed appropriately, avoided when possible, and stopped after surgery.
Lin LA, Brummett CM, Waljee JF, Englesbe MJ, Gunaseelan V, Bohnert ASB. Association of Opioid Overdose Risk Factors and Naloxone Prescribing in US Adults. J Gen Intern Med. 2020;35(2):420-427. doi:10.1007/s11606-019-05423-7
- While there is a growing prevalence of naloxone fills among insured U.S. adults receiving opioids, overall prevalence of naloxone prescribing remains extremely low.
- Key factors associated with opioid overdose risk were also associated with receiving naloxone. However, history of overdose was not associated with filling of a naloxone prescription.
- Substantial further work is needed to increase naloxone access for patients at risk for opioid overdose.
Lee JS, Vu JV, Edelman AL, et al. Health Care Spending and New Persistent Opioid Use After Surgery. Ann Surg. 2020;272(1):99-104. doi:10.1097/SLA.0000000000003399
- For patients undergoing major or minor surgery, new persistent use was associated with significantly higher health care spending during the 180 days after surgery.
- Patients with new persistent opioid use continued to have significantly higher monthly health care spending in contrast to patients who develop other common postoperative complications, in which health care spending returns to baseline by 180 days after surgery.
- Early identification of patients vulnerable to persistent use may enhance the value of surgical care.
Brescia AA, Waljee JF, Hu HM, et al. Impact of Prescribing on New Persistent Opioid Use After Cardiothoracic Surgery. Ann Thorac Surg. 2019;108(4):1107-1113. doi:10.1016/j.athoracsur.2019.06.019
- Among opioid-naïve Medicare patients undergoing cardiothoracic surgery between 2009 and 2015, 12.8% developed new persistent opioid use.
- New persistent opioid use rate declined over time, from 17% in 2009 to 7.1% in 2015.
- Modifiable factors, such as prescription size and preoperative prescription fills, were associated with increased risk of new persistent opioid use. Other patient characteristics associated with higher odds of new persistent opioid use were black race, gastrointestinal complications, disability status, open lung resection, dual eligibility (Medicare and Medicaid), drug and substance abuse, female sex, tobacco use, high comorbidity, pain disorders, longer hospital stay, and younger age.
Santosa KB, Hu HM, Brummett CM, et al. New persistent opioid use among older patients following surgery: A Medicare claims analysis. Surgery. 2020;167(4):732-742. doi:10.1016/j.surg.2019.04.016
- Among opioid naïve Medicare patients who underwent major or minor surgery, 9.8% developed new persistent opioid use.
- Modifiable factors were filled a preoperative opioid, received ≥300 OMEs of opioids in the perioperative period, filled prescriptions for a benzodiazepine, sedative, hypnotic, or anxiolytic within 90 days before surgery.
- High risk prescribing, including filling overlapping opioid prescriptions, having a concurrent benzodiazepine prescription, new receipt of long-acting opioids for acute postsurgical pain, and opioid doses of ≥100 OME, was associated with an increased risk for new persistent opioid use.