Phillip Yang1, Aaron J Bonham2, Arthur M Carlin3, Jonathan F Finks2, Amir A Ghaferi2, Oliver A Varban2. 1. 2926 Taubman Center, University of Michigan Medical School, 1500 E Medical Center Drive, SPC 5343, Ann Arbor, MI, 48109-5343, USA. philyang@umich.edu. 2. Department of Surgery, Michigan Medicine, Ann Arbor, MI, USA. 3. Department of Surgery, Henry Ford Health System, Detroit, MI, USA.
Abstract
BACKGROUND: Obesity-related chronic pain can increase the risk of narcotic abuse in bariatric surgery patients. However, assessment of overdose risk has not been evaluated to date. METHODS: A NARxCHECK® overdose score ("Narx score") was obtained preoperatively on all patients undergoing bariatric surgery (n = 306) between 2018 and 2020 at a single-center academic bariatric surgery program. The 3-digit score ranges from 000 to 999 and is based on patient risk factors found within the Prescription Drug Monitoring Program. A Narx score ≥ 200 indicates tenfold increased risk of narcotic overdose. Patient characteristics, comorbidities, and emergency room (ER) visits were compared between patients in the upper (≥ 200) and lower (000) terciles of Narx scores. Morphine milligram equivalent (MME) prescribed at discharge and refills was also evaluated. RESULTS: Patients in the upper tercile represented 32% (n = 99) of the study population, and compared to the lower tercile (n = 101, 33%), were more likely to have depression (63.6% vs 38.6%, p = 0.0004), anxiety (47.5% vs 30.7%, p = 0.0150), and bipolar disorder (6.1% vs 0.0%, p = 0.0120). Median MME prescribed at discharge was the same between both groups (75); however, high-risk patients were more likely to be prescribed more than 10 tablets of a secondary opioid (83.3% vs 0.0%, p = 0.0111), which was prescribed by another provider in 67% of cases. ER visits among patients who did not have a complication or require a readmission was also higher among high-risk patients (7.8% vs 0.0%, p = 0.0043). There were no deaths or incidents of mental health-related ER visits in either group. CONCLUSION: Patients with a Narx score ≥ 200 were more likely to have mental health disorders and have potentially avoidable ER visits in the setting of standardized opioid prescribing practices. Narx scores can help reduce ER visits by identifying at-risk patients who may benefit from additional clinic or telehealth follow-up.
BACKGROUND: Obesity-related chronic pain can increase the risk of narcotic abuse in bariatric surgery patients. However, assessment of overdose risk has not been evaluated to date. METHODS: A NARxCHECK® overdose score ("Narx score") was obtained preoperatively on all patients undergoing bariatric surgery (n = 306) between 2018 and 2020 at a single-center academic bariatric surgery program. The 3-digit score ranges from 000 to 999 and is based on patient risk factors found within the Prescription Drug Monitoring Program. A Narx score ≥ 200 indicates tenfold increased risk of narcotic overdose. Patient characteristics, comorbidities, and emergency room (ER) visits were compared between patients in the upper (≥ 200) and lower (000) terciles of Narx scores. Morphine milligram equivalent (MME) prescribed at discharge and refills was also evaluated. RESULTS: Patients in the upper tercile represented 32% (n = 99) of the study population, and compared to the lower tercile (n = 101, 33%), were more likely to have depression (63.6% vs 38.6%, p = 0.0004), anxiety (47.5% vs 30.7%, p = 0.0150), and bipolar disorder (6.1% vs 0.0%, p = 0.0120). Median MME prescribed at discharge was the same between both groups (75); however, high-risk patients were more likely to be prescribed more than 10 tablets of a secondary opioid (83.3% vs 0.0%, p = 0.0111), which was prescribed by another provider in 67% of cases. ER visits among patients who did not have a complication or require a readmission was also higher among high-risk patients (7.8% vs 0.0%, p = 0.0043). There were no deaths or incidents of mental health-related ER visits in either group. CONCLUSION: Patients with a Narx score ≥ 200 were more likely to have mental health disorders and have potentially avoidable ER visits in the setting of standardized opioid prescribing practices. Narx scores can help reduce ER visits by identifying at-risk patients who may benefit from additional clinic or telehealth follow-up.
Authors: Nancy J O Birkmeyer; David Share; Darrell A Campbell; Richard L Prager; Mauro Moscucci; John D Birkmeyer Journal: Surgery Date: 2005-11 Impact factor: 3.982
Authors: Anoop R Galivanche; Michael R Mercier; Murillo Adrados; Neil Pathak; Ryan P McLynn; Nidharshan S Anandasivam; Arya G Varthi; Lee E Rubin; Jonathan N Grauer Journal: Spine (Phila Pa 1976) Date: 2019-11-01 Impact factor: 3.468
Authors: Margaret E Smith; Jay S Lee; Aaron Bonham; Oliver A Varban; Jonathan F Finks; Arthur M Carlin; Amir A Ghaferi Journal: Surg Endosc Date: 2018-10-23 Impact factor: 4.584
Authors: Andrew Stokes; Dielle J Lundberg; Katherine Hempstead; Kaitlyn M Berry; Joshua F Baker; Samuel H Preston Journal: Am J Prev Med Date: 2020-03-27 Impact factor: 5.043
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: Ahmed K Emara; Daniel Grits; Alison K Klika; Robert M Molloy; Viktor E Krebs; Wael K Barsoum; Carlos Higuera-Rueda; Nicolas S Piuzzi Journal: Clin Orthop Relat Res Date: 2021-09-01 Impact factor: 4.755
Authors: Andrew Stokes; Kaitlyn M Berry; Jason M Collins; Chia-Wen Hsiao; Jason R Waggoner; Stephen S Johnston; Eric M Ammann; Robin F Scamuffa; Sonia Lee; Dielle J Lundberg; Daniel H Solomon; David T Felson; Tuhina Neogi; JoAnn E Manson Journal: Pain Date: 2019-10 Impact factor: 6.961