Hannah Wunsch1, Andrea D Hill, Jennifer Bethell, Longdi Fu, Brian T Bateman, Karim S Ladha, Duminda N Wijeysundera, Mark D Neuman. 1. Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada Sunnybrook Research Institute, Toronto, Ontario, Canada ICES, Toronto, Ontario, Canada Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada Department of Anesthesia, Perioperative, and Pain Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts Department of Anesthesia, St. Michael's Hospital, Toronto, Ontario, Canada Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania Center for Perioperative Outcomes Research and Transformation, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania Center for Pharmacoepidemiology Research and Training, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
Abstract
OBJECTIVE: The aim of this study was to determine the relationship between surgeon opioid prescribing intensity and subsequent persistent opioid use among patients undergoing surgery. SUMMARY BACKGROUND DATA: The extent to which different postoperative prescribing practices lead to persistent opioid use among surgical patients is poorly understood. METHODS: Retrospective population-based cohort study assessing opioid-naive adults who underwent one of four common surgeries. For each surgical procedure, the surgeons' opioid prescribing intensity was categorized into quartiles based on the median daily dose of morphine equivalents of opioids dispensed within 7 days of the surgical visit for all the surgeons' patients. The primary outcome was persistent opioid use in the year following surgery, defined as 180 days or more of opioids supplied within the year after the index date excluding prescriptions filled within 30 days of the index date. Secondary outcomes included a refill for an opioid within 30 days and emergency department visits and hospitalizations within 1 year. RESULTS: Among 112,744 surgical patients, patients with surgeons in the highest intensity quartile (Q4) were more likely to fill an opioid prescription within 7 days after surgery compared with those in the lowest quartile (Q1) (83.3% Q4 vs 65.4% Q1). In the primary analysis, the incidence of persistent opioid use in the year after surgery was rare in both highest and lowest quartiles (0.3% Q4 vs 0.3% Q1), adjusted odds ratio (AOR) of 1.18, 95% CI 0.83-1.66). However, multiple analyses using stricter definitions of persistent use that included the requirement of a prescription filled within 7 days of discharge after surgery showed a significant association with surgeon quartile (up to an AOR 1.36, 95% CI 1.25, 1.47). Patients in Q4 were more likely to refill a prescription within 30 days (4.8% Q4 vs 4.0% Q1, AOR 1.14, 95% CI 1.04-1.24). CONCLUSIONS: Surgeons' overall prescribing practices may contribute to persistent opioid use and represent a target for quality improvement. However, the association was highly sensitive to the definition of persistent use used.
OBJECTIVE: The aim of this study was to determine the relationship between surgeon opioid prescribing intensity and subsequent persistent opioid use among patients undergoing surgery. SUMMARY BACKGROUND DATA: The extent to which different postoperative prescribing practices lead to persistent opioid use among surgical patients is poorly understood. METHODS: Retrospective population-based cohort study assessing opioid-naive adults who underwent one of four common surgeries. For each surgical procedure, the surgeons' opioid prescribing intensity was categorized into quartiles based on the median daily dose of morphine equivalents of opioids dispensed within 7 days of the surgical visit for all the surgeons' patients. The primary outcome was persistent opioid use in the year following surgery, defined as 180 days or more of opioids supplied within the year after the index date excluding prescriptions filled within 30 days of the index date. Secondary outcomes included a refill for an opioid within 30 days and emergency department visits and hospitalizations within 1 year. RESULTS: Among 112,744 surgical patients, patients with surgeons in the highest intensity quartile (Q4) were more likely to fill an opioid prescription within 7 days after surgery compared with those in the lowest quartile (Q1) (83.3% Q4 vs 65.4% Q1). In the primary analysis, the incidence of persistent opioid use in the year after surgery was rare in both highest and lowest quartiles (0.3% Q4 vs 0.3% Q1), adjusted odds ratio (AOR) of 1.18, 95% CI 0.83-1.66). However, multiple analyses using stricter definitions of persistent use that included the requirement of a prescription filled within 7 days of discharge after surgery showed a significant association with surgeon quartile (up to an AOR 1.36, 95% CI 1.25, 1.47). Patients in Q4 were more likely to refill a prescription within 30 days (4.8% Q4 vs 4.0% Q1, AOR 1.14, 95% CI 1.04-1.24). CONCLUSIONS: Surgeons' overall prescribing practices may contribute to persistent opioid use and represent a target for quality improvement. However, the association was highly sensitive to the definition of persistent use used.
Authors: Richard A Deyo; Sara E Hallvik; Christi Hildebran; Miguel Marino; Eve Dexter; Jessica M Irvine; Nicole O'Kane; Joshua Van Otterloo; Dagan A Wright; Gillian Leichtling; Lisa M Millet Journal: J Gen Intern Med Date: 2016-08-02 Impact factor: 5.128
Authors: Jennifer Bethell; Mark D Neuman; Brian T Bateman; Karim S Ladha; Andrea Hill; Guohua Li; Duminda N Wijeysundera; Hannah Wunsch Journal: Health Rep Date: 2020-07-15 Impact factor: 4.796
Authors: Alex F Peahl; Daniel M Morgan; Vanessa K Dalton; Kara Zivin; Yen-Ling Lai; Hsou Mei Hu; Elizabeth Langen; Lisa Kane Low; Chad M Brummett; Jennifer F Waljee; Melissa E Bauer Journal: Am J Obstet Gynecol Date: 2020-03-23 Impact factor: 8.661
Authors: Karim S Ladha; Mark D Neuman; Gabriella Broms; Jennifer Bethell; Brian T Bateman; Duminda N Wijeysundera; Max Bell; Linn Hallqvist; Tobias Svensson; Craig W Newcomb; Colleen M Brensinger; Lakisha J Gaskins; Hannah Wunsch Journal: JAMA Netw Open Date: 2019-09-04