Publications

Michigan OPEN is driven by data and evidence. Our Prescribing Recommendations and all of our educational materials are shaped by our team’s research and published papers. Below is an up to date document of all of Michigan OPEN’s published research.

Michigan OPEN Publications

If you have any questions pertaining to our publications, please email michiganopen@umich.edu


The following are some of our most cited works.

New Persistent Opioid Use After Minor and Major Surgical Procedures in US Adults

Brummett CM, Waljee JF, Goesling J, et al. New Persistent Opioid Use After Minor and Major Surgical Procedures in US Adults. JAMA Surg. 2017;152(6):e170504. doi:10.1001/jamasurg.2017.0504

  • New persistent opioid use after surgery is common, with approximately 6% of patients who were not on opioids before surgery continuing to use opioids more than 3 months after surgery.
  • Patients continue to use their opioids for reasons other than the pain from surgery.
  • New persistent opioid use after surgery is an underappreciated surgical complication that warrants increased attention.

Persistent Opioid Use Among Pediatric Patients After Surgery

Harbaugh CM, Lee JS, Hu HM, et al. Persistent Opioid Use Among Pediatric Patients After Surgery. Pediatrics. 2018;141(1):e20172439. doi:10.1542/peds.2017-2439

  • Rates of new persistent opioid use among pediatric patients are comparable to those for adults, with 4.8% of patients refilling opioid prescriptions between 3 and 6 months after surgery.
  • Risk factors for new persistent opioid use include type of surgical procedure and patient traits such as older age, female sex, previous substance use disorder, chronic pain, and preoperative opioid fill.
  • Understanding the risks contributing to new persistent opioid use among adolescents and young adults may help clinicians to minimize opioid exposure and reduce risk for later misuse.

Reduction in Opioid Prescribing Through Evidence-Based Prescribing Guidelines

Howard R, Waljee J, Brummett C, Englesbe M, Lee J. Reduction in Opioid Prescribing Through Evidence-Based Prescribing Guidelines. JAMA Surg. 2018;153(3):285-287. doi:10.1001/jamasurg.2017.4436

  • Prior to the intervention, post-laparoscopic cholecystectomy (gall bladder removal surgery) opioid prescribing exceeded patient pain management needs by approximately 88%, based on patient- reported opioid use.
  • Implementation of evidence-based prescribing guidelines reduced post-laparoscopic cholecystectomy opioid prescribing by 63% without increasing the need for medication refills.
  • Patients who received smaller opioid prescriptions after the intervention reported using fewer opioids, indicating that anchoring and adjustment heuristics may impact patient opioid use.

Transitions of Care for Postoperative Opioid Prescribing in Previously Opioid-Naïve Patients in the USA: A Retrospective Review

Klueh MP, Hu HM, Howard RA, et al. Transitions of Care for Postoperative Opioid Prescribing in Previously Opioid-Naïve Patients in the USA: a Retrospective Review. J Gen Intern Med. 2018;33(10):1685-1691. doi:10.1007/s11606-018-4463-1

  • Among surgical patients who developed new persistent opioid use, surgeons provided the majority of opioid prescriptions during the first three months after surgery.
  • By nine to twelve months after surgery, however, the majority of opioid prescriptions were provided by primary care physicians.
  • Enhanced care coordination between surgeons and primary care physicians could allow earlier identification of patients at risk for new persistent opioid use to prevent misuse and dependence.

The Effect of Preoperative Opioid Exposure on Healthcare Utilization and Expenditures Following Elective Abdominal Surgery

Waljee JF, Cron DC, Steiger RM, Zhong L, Englesbe MJ, Brummett CM. Effect of Preoperative Opioid Exposure on Healthcare Utilization and Expenditures Following Elective Abdominal Surgery. Ann Surg. 2017;265(4):715-721. doi:10.1097/SLA.0000000000002117

  • Preoperative opioid use is an independent risk factor for longer hospital stays, higher 30-day readmission rates, higher probability of being discharged to a rehabilitation facility, and greater healthcare expenses in the postoperative period.
  • Identifying strategies to minimize opioid consumption prior to surgery will aid in reducing patient risk, improving outcomes, and lowering healthcare costs.

Persistent Opioid Use after Wisdom Tooth Extraction

Harbaugh CM, Nalliah RP, Hu HM, Englesbe MJ, Waljee JF, Brummett CM. Persistent Opioid Use After Wisdom Tooth Extraction. JAMA. 2018;320(5):504-506. doi:10.1001/jama.2018.9023

  • Approximately 80% of patients who were not using opioids before wisdom tooth extraction filled an opioid prescription at the time of surgery.
  • Opioid prescriptions at the time of wisdom tooth extraction lead to a 3-fold increased odds of developing persistent opioid use in the year after surgery among adolescents and young adults.
  • Given the effectiveness of non-opioid analgesics, the practice of any routine opioid prescribing must be questioned in the face of the potential morbidity and long-term consequences of opioid use.

Patterns of Initial Opioid Prescribing to Opioid-Naive Patients

Larach DB, Waljee JF, Hu HM, et al. Patterns of Initial Opioid Prescribing to Opioid-Naive Patients. Ann Surg. 2020;271(2):290-295. doi:10.1097/SLA.0000000000002969

  • The proportion of initial prescriptions for surgery, emergency, and dental care increased by nearly 16% from 2010 to 2016.
  • Dental care prescribing saw the greatest growth, with a 68% increase, while surgical patients received the highest proportion of potent opioids (90.2%).
  • Evidence-based guidelines for surgical and dental prescribing are necessary to curb iatrogenic opioid morbidity and mortality.

Provider Characteristics Associated with Outpatient Opioid Prescribing After Surgery

Cron DC, Lee JS, Dupree JM, et al. Provider Characteristics Associated With Outpatient Opioid Prescribing After Surgery. Ann Surg. 2020;271(4):680-685. doi:10.1097/SLA.0000000000003013

  • Advanced practice providers account for 1-in-5 postoperative opioid prescriptions.
  • Postoperative opioid prescriptions written by advanced practice providers are 18% larger than those written by physicians.
  • All providers should be involved in postoperative care to understand prescribing practices and identify barriers to reducing prescribing.

Association of Opioid Prescribing with Opioid Consumption After Surgery in Michigan

Howard R, Fry B, Gunaseelan V, et al. Association of Opioid Prescribing With Opioid Consumption After Surgery in Michigan. JAMA Surg. 2019;154(1):e184234. doi:10.1001/jamasurg.2018.4234

  • The quantity of opioid prescribed is associated with higher patient-reported opioid consumption, with patients using .5 more pills for every additional pill prescribed.
  • The use of patient-reported opioid consumption to improve prescribing practices is key to combating the opioid epidemic.

Classifying Preoperative Opioid Use for Surgical Care

Vu JV, Cron DC, Lee JS, et al. Classifying Preoperative Opioid Use for Surgical Care. Ann Surg. 2020;271(6):1080-1086. doi:10.1097/SLA.0000000000003109

  • Preoperative opioid use is common among patients who undergo elective surgery, with 38% filling an opioid prescription in the 12 months before surgery.
  • Even minimal opioid use before surgery increases the probability of needing additional postoperative prescriptions in the 30 days after surgery.
  • Surgeons should take into account any preoperative opioid use in patients when prescribing and coordinating postoperative pain management.

Care Coordination for Patients on Chronic Opioid Therapy Following Surgery

Lagisetty P, Bohnert A, Goesling J, et al. Care Coordination for Patients on Chronic Opioid Therapy Following Surgery: A Cohort Study. Ann Surg. 2020;272(2):304-310. doi:10.1097/SLA.0000000000003235

  • 10% of patients did not have a usual prescriber preoperatively and were more likely to have prescriptions from multiple prescribers and new long-acting opioid prescriptions.
  • 73.8% of patients were exposed to high risk prescribing postoperatively.
  • Among patients with a usual prescriber, earlier return was associated with decreased odds of receiving prescriptions from multiple prescribers.

Statewide Implementation of Postoperative Opioid Prescribing Guidelines

Vu JV, Howard RA, Gunaseelan V, Brummett CM, Waljee JF, Englesbe MJ. Statewide Implementation of Postoperative Opioid Prescribing Guidelines. N Engl J Med. 2019;381(7):680-682. doi:10.1056/NEJMc1905045

  • Evidence-based prescribing guidelines reduced postoperative opioid prescription size across a statewide population without negatively affecting patient satisfaction or pain
  • Despite the reductions in prescription size and opioid use, there were no clinically important changes in satisfaction or pain scores
  • Mean prescription size decreased by 8 pills after the guidelines were released and opioid consumption also decreased by 3 pills

Health Care Spending and New Persistent Opioid Use After Surgery

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.

Association of Opioid Use with Pain and Satisfaction After Dental Extraction

Nalliah RP, Sloss KR, Kenney BC, et al. Association of Opioid Use With Pain and Satisfaction After Dental Extraction. JAMA Netw Open. 2020;3(3):e200901. Published 2020 Mar 2. doi:10.1001/jamanetworkopen.2020.0901

  • Among patients who underwent surgical and routine extractions, patients who used opioids reported higher levels of pain compared with those who did not use opioids
  • No statistically significant difference in satisfaction was found between patients after surgical extraction who used and did not use opioids, and between those after routine extraction who used and did not use opioids.

Association of State Opioid Duration Limits with Postoperative Opioid Prescribing

Agarwal S, Bryan JD, Hu HM, et al. Association of State Opioid Duration Limits With Postoperative Opioid Prescribing. JAMA Netw Open. 2019;2(12):e1918361. Published 2019 Dec 2. doi:10.1001/jamanetworkopen.2019.18361

  • In Massachusetts, the implementation of 7-day limits on initial opioid prescriptions for acute pain was associated with a decrease in prescription size (−38 OMEs) and additional reduction of 1.5 OMEs per month. The implementation was also associated with an average decrease of 0.4 days supplied and the proportion of prescriptions exceeding a 7-day supply (−5.9 percentage points).
  • In contrast, the 7-day limit implementation in Connecticut was not associated with significant changes in opioid prescription.

Assessment of a Quality Improvement Intervention to Decrease Opioid Prescribing in a Regional Health System

Brown CS, Vu JV, Howard RA, Gunaseelan V, Brummett CM, Waljee JF, Englesbe MJ. Assessment of a quality improvement intervention to decrease opioid prescribing in a regional health system. BMJ Quality & Safety.Published Online First: 16 September 2020. doi: 10.1136/bmjqs-2020-011295

  • The use of procedure-specific prescribing guidelines reduced statewide postoperative opioid prescribing by 50%.
  • Opioid consumption also decreased, while satisfaction and postoperative pain remained unchanged.
  • Leveraging the continuous quality improvement infrastructure to implement evidence-based opioid prescribing guidelines has had a meaningful impact on opioid prescription.