Karsten Bartels1, Ana Fernandez-Bustamante2, Shannon K McWilliams3, Christian J Hopfer3, Susan K Mikulich-Gilbertson4. 1. Department of Anesthesiology, University of Colorado, School of Medicine, 13001 East 17th Place, Aurora, CO, 80045, USA; Department of Psychiatry, Division of Substance Dependence, University of Colorado, School of Medicine, 13001 East 17th Place, Aurora, CO, 80045, USA. Electronic address: karsten.bartels@ucdenver.edu. 2. Department of Anesthesiology, University of Colorado, School of Medicine, 13001 East 17th Place, Aurora, CO, 80045, USA. 3. Department of Psychiatry, Division of Substance Dependence, University of Colorado, School of Medicine, 13001 East 17th Place, Aurora, CO, 80045, USA. 4. Department of Psychiatry, Division of Substance Dependence, University of Colorado, School of Medicine, 13001 East 17th Place, Aurora, CO, 80045, USA; Department of Biostatistics and Informatics, University of Colorado, School of Public Health, Anschutz Medical Campus, 13001 East 17th Place, Aurora, CO, 80045, USA.
Abstract
BACKGROUND: Knowledge of incidence and risk factors for long-term opioid prescribing is critical for surgical patients. In this retrospective cohort study, we linked information available at the time of surgery with prescription data to ascertain characteristics associated with prolonged opioid therapy. METHODS: Patients (n = 6003) with claims in the Colorado All Payer Claims Database (APCD) were matched with 20,501 encounters in a clinical database. Rates of prescription filling were defined by at least one monthly opioid claim relative to the date of surgery. Associations of variables with claims during months 2-6 post-operatively ("long-term prescription filling") were evaluated, and significant variables were jointly modeled using binomial regression. RESULTS: Rates of patients filling opioid prescriptions preoperatively [month (M) relative to date of surgery] were 22%(-3 M), 24%(-2 M), and 27%(-1 M); after surgery, opioid fill rates were 62%(1 M), 28%(2 M), 24%(3), 24%(4 M), 23%(5 M), and 22%(6 M). The majority, 71-76%, of patients filling prescriptions in months 2-6 after surgery had also filled before surgery. In the binomial regression model, long-term opioid use was associated with prior opioid use (p < 0.0001), age ≥26 to <65 relative to age ≥ 65 (p < 0.0001), orthopedic surgery (p = 0.001), colorectal surgery (p = 0.003), multiple procedures (p < 0.0001), and worse physical status classification (p < 0.0001). CONCLUSIONS: Patients who had filled opioid prescriptions preoperatively comprised the majority of the group who filled long-term prescriptions. Surgical procedures were associated with discontinuation of previous opioid prescribing in some patients. For others, surgery marked the initiation of prolonged opioid therapy. Surgical encounters should include interventions aimed to reduce long-term opioid use.
BACKGROUND: Knowledge of incidence and risk factors for long-term opioid prescribing is critical for surgical patients. In this retrospective cohort study, we linked information available at the time of surgery with prescription data to ascertain characteristics associated with prolonged opioid therapy. METHODS:Patients (n = 6003) with claims in the Colorado All Payer Claims Database (APCD) were matched with 20,501 encounters in a clinical database. Rates of prescription filling were defined by at least one monthly opioid claim relative to the date of surgery. Associations of variables with claims during months 2-6 post-operatively ("long-term prescription filling") were evaluated, and significant variables were jointly modeled using binomial regression. RESULTS: Rates of patients filling opioid prescriptions preoperatively [month (M) relative to date of surgery] were 22%(-3 M), 24%(-2 M), and 27%(-1 M); after surgery, opioid fill rates were 62%(1 M), 28%(2 M), 24%(3), 24%(4 M), 23%(5 M), and 22%(6 M). The majority, 71-76%, of patients filling prescriptions in months 2-6 after surgery had also filled before surgery. In the binomial regression model, long-term opioid use was associated with prior opioid use (p < 0.0001), age ≥26 to <65 relative to age ≥ 65 (p < 0.0001), orthopedic surgery (p = 0.001), colorectal surgery (p = 0.003), multiple procedures (p < 0.0001), and worse physical status classification (p < 0.0001). CONCLUSIONS:Patients who had filled opioid prescriptions preoperatively comprised the majority of the group who filled long-term prescriptions. Surgical procedures were associated with discontinuation of previous opioid prescribing in some patients. For others, surgery marked the initiation of prolonged opioid therapy. Surgical encounters should include interventions aimed to reduce long-term opioid use.
Authors: Chad M Brummett; Jennifer F Waljee; Jenna Goesling; Stephanie Moser; Paul Lin; Michael J Englesbe; Amy S B Bohnert; Sachin Kheterpal; Brahmajee K Nallamothu Journal: JAMA Surg Date: 2017-06-21 Impact factor: 14.766
Authors: Tiffany C Cox; Ciara R Huntington; Laurel J Blair; Tanushree Prasad; Amy E Lincourt; Brant T Heniford; Vedra A Augenstein Journal: Am J Surg Date: 2016-05-12 Impact factor: 2.565
Authors: Marsha A Raebel; Sophia R Newcomer; Liza M Reifler; Denise Boudreau; Thomas E Elliott; Lynn DeBar; Ameena Ahmed; Pamala A Pawloski; David Fisher; W Troy Donahoo; Elizabeth A Bayliss Journal: JAMA Date: 2013-10-02 Impact factor: 56.272
Authors: Ruchir N Karmali; Christopher Bush; Sudha R Raman; Cynthia I Campbell; Asheley C Skinner; Andrew W Roberts Journal: Pharmacoepidemiol Drug Saf Date: 2019-12-18 Impact factor: 2.890
Authors: Jennifer Hornung Garvin; Kimberly A Herget; Mia Hashibe; Anne C Kirchhoff; Charles W Hawley; Dan Bolton; Carol Sweeney Journal: Health Serv Res Date: 2019-01-24 Impact factor: 3.402
Authors: Karsten Bartels; Katharine Mahoney; Kristen M Raymond; Shannon K McWilliams; Ana Fernandez-Bustamante; Richard Schulick; Christian J Hopfer; Susan K Mikulich-Gilbertson Journal: Surg Endosc Date: 2019-04-03 Impact factor: 4.584
Authors: Sara E Heins; Christine Buttorff; Courtney Armstrong; Rosalie Liccardo Pacula Journal: Drug Alcohol Depend Date: 2021-09-22 Impact factor: 4.492
Authors: Christine Buttorff; George S Wang; Gregory J Tung; Asa Wilks; Daniel Schwam; Rosalie Liccardo Pacula Journal: Med Care Res Rev Date: 2021-12-22 Impact factor: 2.971
Authors: Michael J Buys; Kimberlee Bayless; Jennifer Romesser; Zachary Anderson; Shardool Patel; Chong Zhang; Angela P Presson; Benjamin S Brooke Journal: Reg Anesth Pain Med Date: 2020-08-26 Impact factor: 6.288