Publications
OPEN examines data, clinical practices and strategies to support better pain management, opioid stewardship, policy, treatment and care.
Provider Characteristics Associated with Outpatient Opioid Prescribing After Surgery
Cron DC, Lee JS, Dupree JM, et al. Provider Characteristics Associated With Outpatient Opioid Prescribing After Surgery. Ann Surg. 2020;271(4):680-685. doi:10.1097/SLA.0000000000003013- Advanced practice providers account for 1-in-5 postoperative opioid prescriptions.
- Postoperative opioid prescriptions written by advanced practice providers are 18% larger than those written by physicians.
- All providers should be involved in postoperative care to understand prescribing practices and identify barriers to reducing prescribing.
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.
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.
Patterns of Initial Opioid Prescribing to Opioid-Naïve Patients
Larach DB, Waljee JF, Hu HM, et al. Patterns of Initial Opioid Prescribing to Opioid-Naive Patients. Ann Surg. 2020;271(2):290-295. doi:10.1097/SLA.0000000000002969- The proportion of initial prescriptions for surgery, emergency, and dental care increased by nearly 16% from 2010 to 2016.
- Dental care prescribing saw the greatest growth, with a 68% increase, while surgical patients received the highest proportion of potent opioids (90.2%).
- Evidence-based guidelines for surgical and dental prescribing are necessary to curb iatrogenic opioid morbidity and mortality.
Persistent Opioid Use after Wisdom Tooth Extraction
Harbaugh CM, Nalliah RP, Hu HM, Englesbe MJ, Waljee JF, Brummett CM. Persistent Opioid Use After Wisdom Tooth Extraction. JAMA. 2018;320(5):504-506. doi:10.1001/jama.2018.9023- Approximately 80% of patients who were not using opioids before wisdom tooth extraction filled an opioid prescription at the time of surgery.
- Opioid prescriptions at the time of wisdom tooth extraction lead to a 3-fold increased odds of developing persistent opioid use in the year after surgery among adolescents and young adults.
- Given the effectiveness of non-opioid analgesics, the practice of any routine opioid prescribing must be questioned in the face of the potential morbidity and long-term consequences of opioid use.
Opioid Overdose-the Surgeon’s Role
Vu JV, Lin LA. Opioid Overdose-the Surgeon's Role. Ann Surg. 2018;268(1):32-34. doi:10.1097/SLA.0000000000002713- It is crucial for surgeons to perform a series of preoperative assessments (check for history of substance abuse, previous overdose, past opioid prescriptions, comorbid conditions, etc.) in order to identify patients with an increased risk of opioid overdose.
- More surgeon involvement in research, evidence-based practice, and education will help to combat opioid misuse and overdose after surgery.
The Effect of Preoperative Opioid Use on Healthcare Utilization and Expenditures Following Elective Abdominal Surgery
Waljee JF, Cron DC, Steiger RM, Zhong L, Englesbe MJ, Brummett CM. Effect of Preoperative Opioid Exposure on Healthcare Utilization and Expenditures Following Elective Abdominal Surgery. Ann Surg. 2017;265(4):715-721. doi:10.1097/SLA.0000000000002117- Preoperative opioid use is an independent risk factor for longer hospital stays, higher 30-day readmission rates, higher probability of being discharged to a rehabilitation facility, and greater healthcare expenses in the postoperative period.
- Identifying strategies to minimize opioid consumption prior to surgery will aid in reducing patient risk, improving outcomes, and lowering healthcare costs.
Transitions of Care for Postoperative Opioid Prescribing in Previously Opioid-Naïve Patients in the USA: A Retrospective Review
Klueh MP, Hu HM, Howard RA, et al. Transitions of Care for Postoperative Opioid Prescribing in Previously Opioid-Naïve Patients in the USA: a Retrospective Review. J Gen Intern Med. 2018;33(10):1685-1691.- Among surgical patients who developed new persistent opioid use, surgeons provided the majority of opioid prescriptions during the first three months after surgery.
- By nine to twelve months after surgery, however, the majority of opioid prescriptions were provided by primary care physicians.
- Enhanced care coordination between surgeons and primary care physicians could allow earlier identification of patients at risk for new persistent opioid use to prevent misuse and dependence.
Preoperative Opioid Use is Independently Associated with Increased Costs and Worse Outcomes After Major Abdominal Surgery
Cron DC, Englesbe MJ, Bolton CJ, et al. Preoperative Opioid Use is Independently Associated With Increased Costs and Worse Outcomes After Major Abdominal Surgery. Ann Surg. 2017;265(4):695-701. doi:10.1097/SLA.0000000000001901- The study considered patients at a single center having abdominopelvic surgeries (appendectomy, cholecystectomy, gynecologic and bowel procedures, etc.) and found that patients using opioids preoperatively had 9.2% higher costs.
- Patients with preoperative opioid use had longer length of stay at the hospital, more complications and more readmissions, indicating that preoperative opioid use is a modifiable risk factor for surgery.
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.