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Michigan OPEN
Michigan OPEN
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OPEN examines data, clinical practices and strategies to support better pain management, opioid stewardship, policy, treatment and care.

Health Care Costs 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.

Impact of Prescribing on New Persistent Opioid Use After Cardiothoracic Surgery

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.

New persistent opioid use among older patients following surgery: A Medicare claims analysis.

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.

Rates of New Persistent Opioid Use After Vaginal or Cesarean Birth Among US Women

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 Netw Open. 2019;2(7):e197863. Published 2019 Jul 3. doi:10.1001/jamanetworkopen.2019.7863
  • Rate of new persistent opioid use among women who underwent vaginal delivery was 1.7%, and 2.2% among those 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

Risk of Prolonged Opioid Among Opioid-Naïve Patients After Common Shoulder Arthroscopy Procedures

Gil JA, Gunaseelan V, DeFroda SF, Brummett CM, Bedi A, Waljee JF. Risk of Prolonged Opioid Use Among Opioid-Naïve Patients After Common Shoulder Arthroscopy Procedures. Am J Sports Med. 2019;47(5):1043-1050. doi:10.1177/0363546518819780
  • 3% of patients who underwent common shoulder arthroscopy procedures developed new persistent opioid use.
  • The patient characteristic associated with the highest odds of prolonged opioid use was greater opioid use in the early postoperative period, followed by mental health disorder, alcohol dependence or abuse, female sex, older age and a history of pain diagnosis.
  • Patients at high risk should be provided with appropriate preoperative education regarding their risk and close surveillance and treatment with alternative pain medications during the postoperative period.

New Persistent Opioid Use Following Common Forefoot Procedures for the Treatment of Hallux Valgus (Bunion)

Finney FT, Gossett TD, Hu HM, et al. New Persistent Opioid Use Following Common Forefoot Procedures for the Treatment of Hallux Valgus. J Bone Joint Surg Am. 2019;101(8):722-729. doi:10.2106/JBJS.18.00793
  • The rate of new persistent opioid use among patients who underwent open treatment of hallux valgus was 6.2%
  • Patients who underwent treatment with a first metatarsal-cuneiform arthrodesis were 1.2 times more likely to have new persistent opioid use than those who underwent distal metatarsal osteotomy.
  • Prescriptions filled before surgery and the amount of opioids prescribed are factors that can be modified by the physician to help counsel at-risk patients.

New Persistent Opioid Use and Associated Risk Factors Following Treatment of Ankle Fractures

Gossett TD, Finney FT, Hu HM, et al. New Persistent Opioid Use and Associated Risk Factors Following Treatment of Ankle Fractures. Foot Ankle Int. 2019;40(9):1043-1051. doi:10.1177/1071100719851117
  • The rate of new persistent opioid use among patients who underwent one of four open treatments for an ankle fracture was 8.8%, compared with 6.8% among patients who underwent closed treatment.
  • New persistent opioid use was not directly linked to injury severity.
  • Limiting the peritreatment opioid dose was the largest modifiable risk factor related to new persistent opioid use.

Association Between Long-term Opioid Use in Family Members and Persistent Opioid Use After Surgery Among Adolescents and Young Adults

Harbaugh CM, Lee JS, Chua KP, et al. Association Between Long-term Opioid Use in Family Members and Persistent Opioid Use After Surgery Among Adolescents and Young Adults. JAMA Surg. 2019;154(4):e185838. doi:10.1001/jamasurg.2018.5838
  • Persistent opioid use occurred in 4.1% of patients with long-term opioid use in a family member compared with 2.4% of patients without long-term opioid use in a family member.
  • Long-term opioid use among family members is associated with persistent opioid use among opioid-naïve adolescents and young adults undergoing surgical and dental procedures.
  • Physicians should screen young patients for long-term opioid use in their families

Persistent Opioid Use and High-Risk Prescribing in Body Contouring Patients

Bennett KG, Kelley BP, Vick AD, et al. Persistent Opioid Use and High-Risk Prescribing in Body Contouring Patients. Plast Reconstr Surg. 2019;143(1):87-96. doi:10.1097/PRS.0000000000005084
  • More than 10% of opioid-naïve patients develop persistent opioid use after body contouring surgery.
  • Plastic surgeons must encourage opioid-alternative pain management strategies and optimize transitions of care in vulnerable patients.

Factors Associated with New Persistent Opioid Usage After Lung Resection

Brescia AA, Harrington CA, Mazurek AA, et al. Factors Associated With New Persistent Opioid Usage After Lung Resection. Ann Thorac Surg. 2019;107(2):363-368. doi:10.1016/j.athoracsur.2018.08.057
  • 14% of opioid-naive patients continue to fill opioid prescriptions in the 3 to 6 months after lung resection.
  • Adjuvant therapy and thoracotomy are the greatest risk factors for persistent opioid use following lung resection.
  • Future studies should focus on reducing excess prescribing, perioperative patient education, and safe opioid disposal.
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