Peahl AF, Dalton VK, Montgomery JR, Lai YL, Hu HM, Waljee JF. Rates of New Persistent Opioid Use After Vaginal or Cesarean Birth Among US Women. JAMA Net Open. 2019;2(7):e197863. Published 2019 Jul 3. doi:10.1001/jamanetworkopen.2019.7863
Rate of new persistent opioid use was 1.7% among women who underwent vaginal delivery
Rate of new persistent opioid use was 2.2% among women having cesarean birth.
Modifiable factors, filling an opioid prescription before delivery, and among women underwent vaginal deliveries, receiving a prescription ≥225 OMEs, were associated with increased odds of new persistent use.
Rates of new persistent use have decreased between 2008 and 2016
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.
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.
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.
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.
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.
Cholecystectomy (15.2%) and Colectomy (7.3%) were associated with the highest risk of persistent opioid use.
Patients with persistent opioid use filled additional prescriptions with an average of 200 to 300 OMEs up to 6 months after surgery.
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.
New persistent opioid use after surgery is an underappreciated surgical complication that warrants increased attention.
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.
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.
