Publications (Old)

• Prior to implementation of the modifier 22 opioid sparing vasectomy incentive, 32.5% of men filled an opioid prescription following a vasectomy. After implementation, only 12.6% of men filled an opioid prescription, which is a 19.9% absolute decrease and 61% relative decrease. 
• Estimated the equivalent of 8,743 fewer oxycodone 5mg pills were dispensed in Michigan from July 7, 2019 to November 16, 2020

• Between March 2016 and July 2018, 23 states implemented legislation limiting the duration of initial opioid prescriptions to a maximum of 7 days (17 states limited to 7 days or less, 2 states to 5 days or less, and 4 states to 3 days or less).
• State laws limiting opioid prescriptions to 7 days or less were associated with a reduction in opioid prescribing by 1.7 days per enrollee.

• In Massachusetts, the implementation of 7-day limits on initial opioid prescriptions for acute pain was associated with a decrease in prescription size of 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).
• Limit implementation in Connecticut was not associated with changes in prescription sizes suggesting that opioid duration limits have variable association with postoperative opioid prescribing.

• After hydrocodone was changed from a schedule III to schedule II-controlled substance, the mean OMEs filled in the initial opioid prescription increased by approximately 35 OMEs, equivalent to 7 tablets of hydrocodone. 
• Following the schedule change, an increase in OMEs was observed among patients undergoing general surgery (mean difference of 28 OME), cardiac surgery (123.3 OME), orthopedic surgery (20.5 OME), spine surgery (66 OME), and vascular surgery (47 OME). 
• After scheduling change there was an increase in initial postoperative opioid amounts among opioid-naive patients (mean difference of 16.8 OMEs) and intermittent opioid users (60.3 OME), but not among long term opioid users.

Racial and Ethnic Differences in Elective vs. Emergency Surgery for Colorectal Cancer

Howard, R., Hendren, S., Patel, M., Gunaseelan, V., Wixson, M., Waljee, J., Englesbe, M., & Bicket, M. C. (2022). Racial and Ethnic Differences in Elective vs. Emergency Surgery for Colorectal Cancer. Annals of surgery, 10.1097/SLA.0000000000005667. Advance online publication. https://doi.org/10.1097/SLA.0000000000005667

Five Year Trends in Surgical Technique and Outcomes of Groin Hernia Repair in the United States

Ehlers, A. P., Lai, Y. L., Hu, H. M., Howard, R., Davidson, G. H., Waljee, J. F., Dimick, J. B., & Telem, D. A. (2022). Five year trends in surgical technique and outcomes of groin hernia repair in the United States. Surgical endoscopy, 10.1007/s00464-022-09586-z. Advance online publication. https://doi.org/10.1007/s00464-022-09586-z

Estimation of the Prevalence of Delayed Dispensing Among Opioid Prescriptions From US Surgeons and Dentists

Chua, K. P., Waljee, J. F., Smith, M. A., Bahl, S., Nalliah, R. P., & Brummett, C. M. (2022). Estimation of the Prevalence of Delayed Dispensing Among Opioid Prescriptions From US Surgeons and Dentists. JAMA network open, 5(5), e2214311. https://doi.org/10.1001/jamanetworkopen.2022.14311

The Opioid Epidemic

Upp, L. A., & Waljee, J. F. (2020). The Opioid Epidemic. Clinics in plastic surgery, 47(2), 181–190. https://doi.org/10.1016/j.cps.2019.12.005

Health Care Burden Associated with Outpatient Opioid Use Following Inpatient or Outpatient Surgery

Brummett, C. M., England, C., Evans-Shields, J., Kong, A. M., Lew, C. R., Henriques, C., Zimmerman, N. M., Pawasauskas, J., & Oderda, G. (2019). Health Care Burden Associated with Outpatient Opioid Use Following Inpatient or Outpatient Surgery. Journal of managed care & specialty pharmacy, 25(9), 973–983. https://doi.org/10.18553/jmcp.2019.19055

Disappointing Early Results from Opioid Prescribing Limits for Acute Pain

Chua, K. P., Kimmel, L., & Brummett, C. M. (2020). Disappointing Early Results From Opioid Prescribing Limits for Acute Pain. JAMA surgery, 155(5), 375–376. https://doi.org/10.1001/jamasurg.2019.5891

Limiting Opioid Prescribing-Reply

Chua, K. P., Brummett, C. M., & Waljee, J. F. (2019). Limiting Opioid Prescribing-Reply. JAMA, 322(2), 171–172. https://doi.org/10.1001/jama.2019.5864

• In Michigan, new persistent opioid use rate decreased from 3.29% to 2.51% following the release of prescribing guidelines, which was an additional 0.53% decrease compared to patients outside of Michigan.   
• Mean opioid prescription quantity for patients in Michigan decreased from 199.5 oral morphine equivalents (OMEs) to 88.6 OMEs after prescribing guidelines were released, which was an additional 55.7 OMEs decrease compared to patients outside of Michigan.

• The use of procedure-specific prescribing guidelines reduced statewide postoperative opioid prescribing and consumption by 50%.
• Saw zero change in patient reported satisfaction and pain scores

• Mean prescription size decreased by 8 pills after the guidelines were released and opioid consumption decreased by 3 pills
• Reduced prescription size and opioid use had no impact on patient satisfaction or pain scores

• Five procedures accounted for 95.2% of dental opioid prescriptions, and tooth extraction accounted for almost two-thirds of total prescriptions; 
• Tooth extraction accounted for ⅘ of prescriptions for adolescents and young adults and ⅗ of prescriptions for adults aged 26 through 64 years. 
• In 2018, 45.3% of tooth extractions resulted in 1 or more initial prescriptions

• No significant association between opioid prescription size and satisfaction 
• 83% of patients receiving the smallest opioid prescription (25 mg OME) were satisfied compared to 85% of patients receiving the largest opioid prescription size (750 mg OME)