OPEN examines data, clinical practices and strategies to support better pain management, opioid stewardship, policy, treatment and care.
High-Risk Opioid Prescribing Associated with Postoperative New Persistent Opioid Use in Adolescents and Young AdultsVargas GM; Gunaseelan V; Upp L; Deans KJ; Minneci PC; Gadepalli SK; Englesbe MJ; Waljee JF; Harbaugh CM. High-Risk Opioid Prescribing Associated with Postoperative New Persistent Opioid Use in Adolescents and Young Adults. Annals of Surgery. Published online 27 August 2021. DOI: 10.1097/SLA.0000000000005193
- High-risk opioid prescribing practices increased from 34.9% to 43.5% in opioid-naïve patients aged 13-21 from 2008 to 2016; the largest increase was in co-prescribed benzodiazepines (24.1% to 33.4%).
- High-risk opioid prescribing practices, particularly receiving prescriptions from multiple prescribers across specialties, were associated with a significant increase in adolescent and young adult patients’ risk of persistent opioid use.
- Most opioid prescriptions to patients with persistent use beyond the postoperative period were from non-surgical prescribers (79.6%).
- Among patients not using opioids preoperatively, a history of opioid use was independently associated with new persistent opioid use after surgery, especially those with a history of continuous opioid use.
- Similarly, history of opioid use was independently associated with opioid prescription refill at 1 month after surgery.
- Moderate to high alcohol use was associated with new persistent use as well as opioid prescription refill at 1 month
- Among patients admitted for traumatic injury, 8.6% developed new persistent opioid use.
- Patients suffering from extremity and abdominal injuries are at highest risk.
- Maximum individual region injury severity predicts development of new persistent use, whereas total injury severity does not.
Endovascular surgery is not protective against new persistent opioid use development compared to open vascular surgeryBrown CS; Osborne NH; Hu HM; Coleman D; Englesbe MJ; Waljee JF; Brummett CM; Vemuri C. Endovascular surgery is not protective against new persistent opioid use development compared to open vascular surgery. Vascular. Published online 15 June 2021. DOI: 10.1177/17085381211024514
- Among opioid-naïve patients undergoing vascular surgery procedures in Medicare between 2009 and 2017, 2.6% of all patients developed new persistent use.
- Undergoing endovascular carotid or venous surgery was associated with an increased risk of NPOU, whereas no differences were found between endovascular and open approaches for peripheral arterial or aortic disease.
- Exposure to opioids in the perioperative period is associated with new persistent use in patients who were previously opioid-naïve. New persistent opioid use was higher in patients having an initial perioperative opioid fill (3.4%) than patients without an initial perioperative fill (0.6%).
- After adjusting for patient characteristics, initial perioperative opioid fill was independently associated with an increased odds of new persistent use.
- Surgeons should be aware of those risks to identify at-risk patients in the current national opioid crisis and minimize prescribing opioids when possible.
- Over 2% of ambulatory anorectal procedures develop new persistent opioid use.
- Logistic regression found new persistent opioid use was associated with perioperative opioid fills, increased comorbidity, tobacco use, and pain disorders; there was no significant association with procedure performed.
- Despite small annual reductions in opioid prescriptions, there has been little change in the amount prescribed.
- This demonstrates a need to develop and disseminate best practices for anorectal surgery, focusing on eliminating unnecessary opioid prescribing.
- 1.5% of patients develop new persistent opioid use after inguinal hernia repair.
- The strongest risk factor for this complication was filling an opioid prescription in the 30 days prior to surgery, which was most commonly provided by a surgeon.
- Other risk factors for new persistent opioid use included receiving a larger opioid prescription, having more comorbidities, having a major postoperative complication, and certain mental health disorders and pain disorders.
- 0% of pregnant women filled an opioid prescription during pregnancy, and 4.0% of the women who filled developed new persistent opioid use.
- Having a non-delivery procedure in pregnancy and having an emergency room visit during pregnancy are factors associated with filling an opioid in pregnancy
- Filling a peripartum opioid prescription (1 week prior to or 3 days post-discharge) was significantly associated with new persistent opioid use.
High-Risk Prescribing Increases Rates of New Persistent Opioid Use in Total Hip Arthroplasty PatientsDelaney 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.
- 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.