New, Persistent Opioid Use Common After Surgery

Approximately 6% of patients undergoing both minor and major surgical procedures continued to use opioids 90 days after surgery, according to a study of nationwide insurance claims data.

The incidence of new persistent opioid use was similar between the minor surgery (5.9%) and major surgery groups (6.5%) for an odds ratio of 1.12 (95% CI 1.01-1.24), reported Chad M. Brummett, MD, of the University of Michigan Medical School in Ann Arbor, and colleagues in JAMA Surgery.

Conversely, the incidence of filling an opioid prescription between 90 to 180 days after a fictitious surgery date was just 0.4% in the nonsurgical comparison group, they said.

“New persistent opioid use after surgery is common and is not significantly different between minor and major surgical procedures but rather associated with behavioral and pain disorders,” the authors wrote. “This suggests its use is not due to surgical pain but addressable patient-level predictors. New persistent opioid use represents a common but previously underappreciated surgical complication that warrants increased awareness.”

Brummett’s group used the Clinformatics Data Mart, a nationwide insurance claims data set, to identify U.S. adults who underwent surgical procedures from 2013 to 2014, and filled an opioid prescription either in the month prior to surgery or within 2 weeks after discharge. Mean age of participants was 44.6 and the cohort was predominately female (66.1%) and white (72.1%).

They examined a total of 36,177 patients: 29,068 (80.3%) who received minor surgical procedures and 7,109 (19.7%) who received major procedures. Minor surgical procedures included varicose vein removal, laparoscopic cholecystectomy, laparoscopic appendectomy, hemorrhoidectomy, thyroidectomy, transurethral prostate surgery, parathyroidectomy, and carpal tunnel. Major surgical procedures included ventral incisional hernia repair, colectomy, reflux surgery, bariatric surgery, and hysterectomy.

The researchers also created a comparison cohort based off of a 10% sample of patients who did not undergo surgery in the study period (n=492,177).

They calculated the incidence of persistent opioid use for more than 90 days among opioid-naive patients after both minor surgical procedures and major surgical procedures, as well as assessed data for patient-level predictors of persistent opioid use.

Brummett’s group reported that the rates of prolonged opioid use were similar between both surgery groups and that patients with a greater number of comorbidities were particularly vulnerable to prolonged use.

The mean number of opioid prescriptions was 1.4 and mean number of pills was 53. Of those filling a prescription between 90 and 180 days after surgery, the mean number in the study period was 3.3 with a mean of 125 pills.

The researchers also reported risk factors that were independently associated with new persistent opioid use, including preoperative tobacco use (adjusted OR 1.35, 95% CI 1.21-1.49), alcohol and substance abuse disorders (aOR 1.34, 95% CI 1.05-1.72), mood disorders (aOR 1.15, 95% CI 1.01-1.30), and anxiety (aOR 1.25, 95% CI 1.10-1.42).

Another factor was preoperative pain disorders: back pain (aOR 1.57, 95% CI 1.42-1.75), neck pain (aOR 1.22, 95% CI 1.07-1.39), arthritis (aOR 1.56, 95% CI 1.40-1.73), and centralized pain (aOR 1.39, 95% CI 1.26-1.54).

The researchers concluded that despite the sharp focus on the opioid epidemic, there has been little attention placed on postoperative prescribing.

“While the CDC guidelines and an increased attention on long-term outpatient management of opioids has and will continue to decrease opioid prescribing, the effect of postoperative use on the opioid overdose epidemic has been less recognized.” “To our knowledge, there are currently no normative data for postoperative opioid prescribing to guide practice, and as such, it has become an issue of convenience and little attention has been placed on the potential morbidity to follow.”

Study limitations included the inability to capture actual opioid consumption and a potential lack of generalizability to the uninsured, underinsured, and individuals ≥65.

Article reposted from MedPage Today

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