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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.

Inappropriate Preoperative Gabapentinoid Use Among Patients With Carpal Tunnel Syndrome

Billig JI, Sears ED, Gunaseelan V, et al. Inappropriate Preoperative Gabapentinoid Use Among Patients With Carpal Tunnel Syndrome. J Hand Surg Am. 2020;45(8):677-689.e5. doi:10.1016/j.jhsa.2020.04.011
  • 6% of patients are prescribed a gabapentinoid prior to surgery
  • Of the patients with preoperative gabapentinoid use, 24% had prolonged gabapentinoid use and 20% of the preoperative gabapentinoid users also filled opioid prescriptions at 91 to 180 days after carpal tunnel release
  • Given the effectiveness of surgical release and the risks associated with gabapentinoids, greater attention is needed to ensure that gabapentinoids are prescribed appropriately, avoided when possible, and stopped after surgery.

Association of Opioid Overdose Risk Factors and Naloxone Prescribing in US Adults

Lin LA, Brummett CM, Waljee JF, Englesbe MJ, Gunaseelan V, Bohnert ASB. Association of Opioid Overdose Risk Factors and Naloxone Prescribing in US Adults. J Gen Intern Med. 2020;35(2):420-427. doi:10.1007/s11606-019-05423-7
  • While there is a growing prevalence of naloxone fills among insured U.S. adults receiving opioids, overall prevalence of naloxone prescribing remains extremely low.
  • Key factors associated with opioid overdose risk were also associated with receiving naloxone. However, history of overdose was not associated with filling of a naloxone prescription.
  • Substantial further work is needed to increase naloxone access for patients at risk for opioid overdose.

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

Statewide Implementation of Postoperative Opioid Prescribing Guidelines

Vu JV, Howard RA, Gunaseelan V, Brummett CM, Waljee JF, Englesbe MJ. Statewide Implementation of Postoperative Opioid Prescribing Guidelines. N Engl J Med. 2019;381(7):680-682. doi:10.1056/NEJMc1905045
  • Evidence-based prescribing guidelines reduced postoperative opioid prescription size across a statewide population without negatively affecting patient satisfaction or pain
  • Despite the reductions in prescription size and opioid use, there were no clinically important changes in satisfaction or pain scores
  • Mean prescription size decreased by 8 pills after the guidelines were released and opioid consumption also decreased by 3 pills

Eliminating Unnecessary Opioid Exposure After Common Children’s Surgeries

Harbaugh CM, Vargas G, Streur CS, et al. Eliminating Unnecessary Opioid Exposure After Common Children's Surgeries. JAMA Surg. 2019;154(12):1154-1155. doi:10.1001/jamasurg.2019.2529
  • A discharge opioid was prescribed to 22% of 675 children younger than 18 years with median 10 doses (25th to 75th percentile, 6-15) undergoing umbilical or epigastric herniorrhaphy; laparoscopic appendectomy; inguinal herniorrhaphy and/or hydrocelectomy; adenoidectomy; circumcision; percutaneous pinning for elbow fracture; or scrotal-incision orchiopexy at a tertiary care facility.
  • Circumcision, elbow fracture, and orchiopexy had the highest opioid use; yet only 1 in 3 patients used an opioid, typically for 3 days or less.
  • Overall, pain control was reported as good among 82% of children with or without a discharge opioid prescription.

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.
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