Ryan Howard1, Craig S Brown, Yen-Ling Lai, Vidhya Gunaseelan, Chad M Brummett, Michael Englesbe, Jennifer Waljee, Mark C Bicket. 1. Department of Surgery, Michigan Medicine, Ann Arbor, Michigan Center for Healthcare Outcomes and Policy, Michigan Medicine, Ann Arbor, Michigan Michigan Opioid Prescribing and Engagement Network, Institute for Healthcare Policy and Innovation, Ann Arbor, Michigan Department of Anesthesiology, Michigan Medicine, Ann Arbor, Michigan.
Abstract
OBJECTIVE: Evaluate the association between postoperative opioid prescribing and new persistent opioid use. SUMMARY BACKGROUND DATA: Opioid-naïve patients who develop new persistent opioid use after surgery are at increased risk of opioid-related morbidity and mortality. However, the extent to which postoperative opioid prescribing is associated with persistent postoperative opioid use is unclear. METHODS: Retrospective study of opioid-naïve adults undergoing surgery in Michigan from 1/1/2017-10/31/2019. Postoperative opioid prescriptions were identified using a statewide clinical registry and prescription fills were identified using Michigan's prescription drug monitoring program. The primary outcome was new persistent opioid use, defined as filling at least one opioid prescription between post-discharge days 4-90 and filling at least one opioid prescription between post-discharge days 91-180. RESULTS: 37,654 patients underwent surgery with a mean age of 52.2 (16.7) years and 20,923 (55.6%) female patients. 31,920 (84.8%) patients were prescribed opioids at discharge. 622 (1.7%) patients developed new persistent opioid use after surgery. Being prescribed an opioid at discharge was not associated with new persistent opioid use (aOR 0.88 [95% CI 0.71-1.09]). However, among patients prescribed an opioid, patients prescribed the second largest (12 [IQR 3] pills) and largest (20 [IQR 7] pills) quartiles of prescription size had higher odds of new persistent opioid use compared to patients prescribed the smallest quartile (7 [IQR 1] pills) of prescription size (aOR 1.39 [95% CI 1.04-1.86]) and aOR 1.97 [95% CI 1.44-2.70], respectively). CONCLUSIONS: In a cohort of opioid-naïve patients undergoing common surgical procedures, the risk of new persistent opioid use increased with the size of the prescription. This suggests that while opioid prescriptions in and of themselves may not place patients at risk of long-term opioid use, excessive prescribing does. Consequently, these findings support ongoing efforts to mitigate excessive opioid prescribing after surgery to reduce opioid-related harms.
OBJECTIVE: Evaluate the association between postoperative opioid prescribing and new persistent opioid use. SUMMARY BACKGROUND DATA: Opioid-naïve patients who develop new persistent opioid use after surgery are at increased risk of opioid-related morbidity and mortality. However, the extent to which postoperative opioid prescribing is associated with persistent postoperative opioid use is unclear. METHODS: Retrospective study of opioid-naïve adults undergoing surgery in Michigan from 1/1/2017-10/31/2019. Postoperative opioid prescriptions were identified using a statewide clinical registry and prescription fills were identified using Michigan's prescription drug monitoring program. The primary outcome was new persistent opioid use, defined as filling at least one opioid prescription between post-discharge days 4-90 and filling at least one opioid prescription between post-discharge days 91-180. RESULTS: 37,654 patients underwent surgery with a mean age of 52.2 (16.7) years and 20,923 (55.6%) female patients. 31,920 (84.8%) patients were prescribed opioids at discharge. 622 (1.7%) patients developed new persistent opioid use after surgery. Being prescribed an opioid at discharge was not associated with new persistent opioid use (aOR 0.88 [95% CI 0.71-1.09]). However, among patients prescribed an opioid, patients prescribed the second largest (12 [IQR 3] pills) and largest (20 [IQR 7] pills) quartiles of prescription size had higher odds of new persistent opioid use compared to patients prescribed the smallest quartile (7 [IQR 1] pills) of prescription size (aOR 1.39 [95% CI 1.04-1.86]) and aOR 1.97 [95% CI 1.44-2.70], respectively). CONCLUSIONS: In a cohort of opioid-naïve patients undergoing common surgical procedures, the risk of new persistent opioid use increased with the size of the prescription. This suggests that while opioid prescriptions in and of themselves may not place patients at risk of long-term opioid use, excessive prescribing does. Consequently, these findings support ongoing efforts to mitigate excessive opioid prescribing after surgery to reduce opioid-related harms.