Publications
OPEN examines data, clinical practices and strategies to support better pain management, opioid stewardship, policy, treatment and care.
Association between Insurance Cost-sharing Subsidy and Postoperative Opioid Prescription Refills among Medicare Patients
Kirsch M, Montgomery JR, Hu HM, et al. Association between insurance cost-sharing subsidy and postoperative opioid prescription refills among Medicare patients. Surgery. 2020;168(2):244-252. doi:10.1016/j.surg.2020.04.013- 6% of Medicare patients in Michigan who underwent orthopedic procedures filled an opioid prescription after the procedure, and 66.4% of patients who filled a prescription refilled another opioid prescription within 90 days of discharge.
- Among patients with full low-income subsidy, the odds of filling an initial postoperative prescription were 1.29 times higher, and the odds of refilling another prescription were 1.39 times higher than patients without low-income subsidy.
Increased opioid prescription fills after dental procedures performed before weekends and holidays
Priest CR, Kenney BC, Brummett CM, Waljee JF, Englesbe MJ, Nalliah RP. Increased opioid prescription fills after dental procedures performed before weekends and holidays. J Am Dent Assoc. 2020;151(6):388-398.e1. doi:10.1016/j.adaj.2020.03.014- Patients with dental procedures the day before weekends and holidays were more likely to fill an opioid prescription than patients with procedures on other weekdays, an odds ratio 1.27.
- The odds of filling an opioid prescription for patients aged 13 to 29 were 1.43 times of the odds for patients aged 50-64 years.
The Association Between Preoperative Opioid Exposure and Prolonged Postoperative Use
Katzman C, Harker EC, Ahmed R, et al. The Association Between Preoperative Opioid Exposure and Prolonged Postoperative Use [published online ahead of print, 2020 May 18]. Ann Surg. 2020; doi:10.1097/SLA.0000000000003723- 41% of patients had nonchronic, periodic opioid fills in the year prior to general, gynecologic, and urologic surgical procedures.
- Patterns of preoperative fills were most strongly associated with persistent postoperative opioid use. Patients with recent intermittent use were significantly more likely to have prolonged fills after surgery compared with opioid-naïve patients
- Identifying opioid use before surgery is a critical opportunity to optimize care after surgery.
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.
Spillover Effect of Evidence-Based Postoperative Opioid Prescribing
Howard R, Alameddine M, Klueh M, et al. Spillover Effect of Evidence-Based Postoperative Opioid Prescribing [published correction appears in J Am Coll Surg. 2019 Apr;228(4):720]. J Am Coll Surg. 2018;227(3):374-381. doi:10.1016/j.jamcollsurg.2018.06.007- After introducing evidence-based prescribing recommendations for laparoscopic cholecystectomy, prescribing decreased for four other surgical procedures, with no significant increase in refill requests.
- Implementing evidence-based prescribing recommendations contributes to increased awareness of safe and appropriate opioid prescribing practices.
Association of Hydrocodone Schedule Change with Opioid Prescriptions Following Surgery
Habbouche J, Lee J, Steiger R, et al. Association of Hydrocodone Schedule Change With Opioid Prescriptions Following Surgery [published correction appears in JAMA Surg. 2018 Dec 1;153(12):1164]. JAMA Surg. 2018;153(12):1111-1119. doi:10.1001/jamasurg.2018.2651- 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.
- Opioid-related policies, and any subsequent edits, must be closely monitored to identify unintended effects.
Probability of Opioid Prescription Refilling After Surgery: Does Initial Prescription Dose Matter?
Sekhri S, Arora NS, Cottrell H, et al. Probability of Opioid Prescription Refilling After Surgery: Does Initial Prescription Dose Matter?. Ann Surg. 2018;268(2):271-276. doi:10.1097/SLA.0000000000002308- Approximately 9% of patients who were not using opioids preoperatively refilled an opioid prescription after surgery.
- The probability of a patient refilling a postoperative opioid prescription was not correlated with their initial prescription strength.
- Surgeons could prescribe smaller opioid prescriptions without influencing the probability of a refill request.
Postoperative Opioid Prescribing and the Pain Scores on Hospital Consumer Assessment of Healthcare Providers and Systems Survey
Lee JS, Hu HM, Brummett CM, et al. Postoperative Opioid Prescribing and the Pain Scores on Hospital Consumer Assessment of Healthcare Providers and Systems Survey. JAMA. 2017;317(19):2013-2015. doi:10.1001/jama.2017.2827- The Center for Medicare & Medicaid Services’ Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) captures key elements of patient satisfaction, including pain management. The study found no correlation between HCAHPS pain measures and postoperative opioid prescribing in surgical patients in Michigan.
- Clinicians can feel empowered to reduce their initial opioid prescription without harming patient satisfaction or their hospitals’ reimbursement.