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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.

The Association of Postoperative Opioid Prescriptions with Patient Outcomes

Howard, R; Brown, CS; Lai, YL; Gunaseelan, V; Chua, KP; Brummett, C; Englesbe, M; Waljee, J; Bicket, MC. The Association of Postoperative Opioid Prescriptions with Patient Outcomes. Annals of Surgery. Published online 4 June 2021. DOI: 10.1097/SLA.0000000000004965
  • Patients who were not prescribed opioids after surgery had similar clinical and patient-reported outcomes as patients who were prescribed opioids.
  • This suggests that minimizing opioids as part of routine postoperative care is unlikely to adversely affect patients.

The Impact of Complications and Pain on Patient Satisfaction

Berkowitz R, Vu J, Brummett C, Waljee J, Englesbe M, Howard R. The Impact of Complications and Pain on Patient Satisfaction. Annals of Surgery. Published online 1 June 2021. DOI: 10.1097/SLA.0000000000003621
  • The predicted probability of being highly satisfied after surgery was 79% for patients who had no complications and 88% for patients who had no pain.
  • Patients who experienced postoperative complications and pain were less likely to be highly satisfied or have no regret.
  • Notably, postoperative pain has a more significant effect on satisfaction and regret after surgery, suggesting focused postsurgical pain management is an opportunity to substantially improve patient experiences.

A Qualitative Study of Patient Protection against Postoperative Opioid Addiction: A Thematic Analysis of Self-Agency

Cho HE, Billig JI, Byrnes ME, Nasser JS, Kocheril AP, Haase SC, Waljee JF, Chung KC. A Qualitative Study of Patient Protection against Postoperative Opioid Addiction: A Thematic Analysis of Self-Agency. Plastic and Reconstructive Surgery. Published online 1 May 2021. DOI: 10.1097/PRS.0000000000007841
  • Participants actively sought out protective mechanisms supporting their decision on opioid use, but sometimes did so unconsciously. Participants integrated a strong sense of self in their decision-making processes.
  • A robust understanding of how patients choose to take opioids for postoperative pain control is imperative to develop patient-centered strategies to treat the opioid epidemic.
  • Effective opioid-reduction policies should consider patients as active agents who negotiate various internal and external influences in their decision-making processes.

Dental Opioid Prescriptions and Overdose Risk in Patients and Their Families

Chua KP, Kenney BC, Waljee JF, Brummett CM, Nalliah RP. Dental Opioid Prescriptions and Overdose Risk in Patients and Their Families. American Journal of Preventive Medicine. Published online 29 April 2021. DOI: 10.1016/j.amepre.2021.02.008
  • Initial opioid prescriptions after dental procedures were associated with a higher risk of opioid overdose in patients.
  • The magnitude of increased risk was greater in patients who were publicly insured and in patients who had mental health or substance use disorders. Among privately insured patients in family plans, initial opioid prescriptions after dental procedures were associated with a higher risk of overdose in patients’ family members.
  • These findings highlight the importance of avoiding unnecessary dental opioid prescribing.

Persistent Opioid Use After Ophthalmic Surgery in Opioid-Naïve Patients and Associated Risk Factors

Ung C; Yonekawa Y; Waljee JF; Gunaseelan V; Lai Y; Woodward MA. Persistent Opioid Use After Ophthalmic Surgery in Opioid-Naïve Patients and Associated Risk Factors. Ophthalmology. Published online 22 April 2021. DOI: https://doi.org/10.1016/j.ophtha.2021.04.021
  • 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.

Persistent Opioid Use Associated With Dental Opioid Prescriptions Among Publicly and Privately Insured US Patients, 2014 to 2018

Chua KP; Hu HM; Waljee JF; Nalliah RP; Brummett CM; Persistent Opioid Use Associated With Dental Opioid Prescriptions Among Publicly and Privately Insured US Patients, 2014 to 2018. JAMA Network Open. Published online 16 April 2021. DOI: 10.1001/jamanetworkopen.2021.6464
  • Persistent opioid use was defined as 1 or more dispensed opioid prescriptions 4 to 90 days after the index date and 1 or more prescriptions 91 to 365 days after the index date. Overall POU was 1.3%, and the risk of POU was higher among publicly insured (2.0%) than privately insured patients (0.9%).
  • The initial dental opioid prescriptions were associated with a 1.0–percentage point higher risk of POU among publicly insured patients compared with privately insured patients.
  • The results further highlight the importance of avoiding dental opioid prescribing when nonopioids provide effective analgesia, which is the case for most dental procedures.

Predicting postoperative opioid use with machine learning and insurance claims in opioid-naïve patients

Hur J; Tang S; Gunaseelan V; Vu J; Brummett CM; Englesbe MJ; Waljee JF; Wiens J. Predicting postoperative opioid use with machine learning and insurance claims in opioid-naïve patients. American Journal of Surgery. Published online 26 March 2021. DOI: https://doi.org/10.1016/j.amjsurg.2021.03.058
  • Potential predictors included sociodemographic data, comorbidities, and prescriptions within one year prior to surgery.
  • Undergoing major surgery, opioid prescriptions within 30 days prior to surgery, and abdominal pain were useful in predicting refills; back/joint/head pain were the most important features in predicting new persistent use.
  • Preoperative patient attributes from insurance claims could potentially be useful in guiding prescription practices for opioid-naïve patients.

Opioid prescribing patterns by dental procedure among US publicly and privately insured patients, 2013 through 2018

Chua KP; Hu HM; Waljee JF; Brummett CM; Nalliah RP. Opioid prescribing patterns by dental procedure among US publicly and privately insured patients, 2013 through 2018. JADA. Published online 23 February 2021. DOI: https://doi.org/10.1016/j.adaj.2021.01.001
  • Five procedures accounted for 95.2% of dental opioid prescriptions, and tooth extraction accounted for almost two-thirds of total prescriptions.
  • Opioid prescribing for tooth extractions is declining but remains common, despite the availability of equally effective nonopioid alternatives.
  • Eliminating routine opioid prescribing for tooth extraction could reduce dental opioid exposure substantially.

Association of Postoperative Opioid Prescription Size and Patient Satisfaction

Fry BT; Howard RA; Gunaseelan V; Lee JS; Waljee JF; Englesbe MJ; Vu JV. Association of Postoperative Opioid Prescription Size and Patient Satisfaction. Annals of Surgery. Published online 1 February 2021. DOI: 10.1097/SLA.0000000000004784
  • In a large cohort of patients undergoing common surgical procedures, there was no association between opioid prescription size at discharge after surgery and patient satisfaction.
  • This suggests surgeons may continue to decrease postoperative opioid prescription sizes in order to mitigate opioid-related risks without compromising patient satisfaction.

Association of Opioid Type with Opioid Consumption after Surgery

Zikovich S; Gunaseelan V; Englesbe MJ; Waljee JF; Brummett CM. Association of Opioid Type with Opioid Consumption after Surgery. Annals of Surgery. Published online 10 February 2021. DOI: 10.1097/SLA.0000000000004793
  • Patients prescribed hydrocodone consumed 7 tablets (95% CI 6.79-7.18) while patients prescribed oxycodone consumed 6 tablets (95% CI 5.58-6.40.)
  • Although patients prescribed hydrocodone consumed more tablets than patients prescribed oxycodone, this difference was not clinically significant and did not result in differences in satisfaction, pain, or refills.
  • Perioperative opioid prescribing guidelines may recommend the same number of 5 mg oxycodone and hydrocodone tablets without sacrificing patient-reported outcomes.
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