IMPORTANCE There is growing evidence that opioids are overprescribed following surgery. Improving prescribing requires understanding factors associated with opioid consumption. OBJECTIVE To describe opioid prescribing and consumption for a variety of surgical procedures and determine factors associated with opioid consumption after surgery. DESIGN, SETTING, AND PARTICIPANTS A retrospective, population-based analysis of the quantity of opioids prescribed and patient-reported opioid consumption across 33 health systems in Michigan, using a sample of adults 18 years and older undergoing surgery. Patients were included if they were prescribed an opioid after surgery. Surgical procedures took place between January 1, 2017, and September 30, 2017, and were included if they were performed in at least 25 patients. EXPOSURES Opioid prescription size in the initial postoperative prescription. MAIN OUTCOMES AND MEASURES Patient-reported opioid consumption in oral morphine equivalents. Linear regression analysis was used to calculate risk-adjusted opioid consumption with robust standard errors. RESULTS In this study, 2392 patients (mean age, 55 years; 1353 women [57%]) underwent 1 of 12 surgical procedures. Overall, the quantity of opioid prescribed was significantly higher than patient-reported opioid consumption (median, 30 pills; IQR, 27-45 pills of hydrocodone/acetaminophen, 5/325 mg, vs 9 pills; IQR, 1-25 pills; P < .001). The quantity of opioid prescribed had the strongest association with patient-reported opioid consumption, with patients using 0.53 more pills (95% CI, 0.40-0.65; P < .001) for every additional pill prescribed. Patient-reported pain in the week after surgery was also significantly associated with consumption but not as strongly as prescription size. Compared with patients reporting no pain, patients used a mean (SD) 9 (1) more pills if they reported moderate pain and 16 (2) more pills if they reported severe pain (P < .001). Other significant risk factors included history of tobacco use, American Society of Anesthesiologists class, age, procedure type, and inpatient surgery status. After adjusting for these risk factors, patients in the lowest quintile of opioid prescribing had significantly lower mean (SD) opioid consumption compared with those in the highest quintile (5 [2] pills vs 37 [3] pills; P < .001). CONCLUSIONS AND RELEVANCE The quantity of opioid prescribed is associated with higher patient-reported opioid consumption. Using patient-reported opioid consumption to develop better prescribing practices is an important step in combating the opioid epidemic.

Opioids are widely overprescribed after surgery. 1 Leftover medication is often diverted into the community, contributing to the opioid epidemic. 2 The lack of evidence regarding ideal prescribing practice after surgery may hinder efforts to reduce overprescribing. 3 In this study, we developed and disseminated postoperative prescribing guidelines and measured the impact on prescribing in a statewide hospital collaborative.

Postprescription review of study-ABX decreased antimicrobial utilization in some of the study hospitals and may be more effective when performed as part of an established ASP.

Background-Opioid-related morbidity and mortality is a major public health problem, and the risk of long-term opioid use following surgery is not well defined. Hypothesis/Purpose-Substance dependence, pain disorders, and psychiatric conditions increase the risk for prolonged opioid use. Study Design-Prospective Cohort Methods-Insurance claims data from Truven MarketScan was used to identify patients who underwent shoulder arthroscopy between January 1, 2010 and March 31, 2015. We included opioid naïve patients, defined as patients who did not fill an opioid prescription within 11 months before the perioperative period. New prolonged opioid use was defined as continued opioid use between 91 and 180 days following the index procedure. We used a multivariable logistic regression model to identify patient factors associated with the risk of new prolonged opioid use. An adjusted persistent use rate was calculated by surgery type. Results-In this cohort of 104154 opioid-naïve adult patients who underwent an arthroscopic shoulder procedure between January 1, 2010 and March 31, 2015, 8686 patients (8.3%) developed new prolonged opioid use as defined in this study. 31768 (30.5%) patients filled an opioid prescription in the 30 days prior to surgery. Patients who had a limited debridement had the highest prolonged use rate (9.0%), followed by rotator cuff repair (8.5%), anterior labrum lesion repair (8.5%), and extensive debridement (8.2%). Patients with the highest ORs of prolonged opioid use included those patients who had a total opioid dose (OME) during the perioperative period that was 743 OME or greater (i.e. at least 149 tablets of 5mg Hydrocodone) (OR, 2.0; 95% confidence interval [CI], 1.9-2.1), followed by patients with a suicide and self-harm disorder (OR, 2.0; 95% CI, 1.1-3.4), history of alcohol dependence or abuse (OR, 1.6; 95% CI, 1.3-1.9), a mood disorder (OR, 1.3; 95% CI, 1.2-1.4), patients who filled an opioid prescription in the 30 days prior to surgery (1.

Objective: We characterized patterns of preoperative opioid use in patients undergoing elective surgery to identify the relationship between preoperative use and subsequent opioid fill after surgery. Background: Preoperative opioid use is common, and varies by dose, recency, duration, and continuity of fills. To date, there is little evidence to guide postoperative prescribing need based on prior opioid use. Methods: We analyzed claims data from Clinformatics® DataMart Database for patients aged 18-64 years undergoing major and minor surgery between 2008 and 2015. Preoperative use was defined as any opioid prescription filled in the year before surgery. We used cluster analysis to group patients by the dose, recency, duration, and continuity of use. Our primary outcome was second postoperative fill within 30 postoperative days. Our primary explanatory variable was opioid use group. We used logistic regression to examine likelihood of second fill by opioid use group. Results: Out of 267,252 patients, 102,748 (38%) filled an opioid prescription in the 12 months before surgery. Cluster analysis yielded 6 groups of preoperative opioid use, ranging from minimal (27.6%) to intermittent (7.7%) to chronic use (2.7%). Preoperative opioid use was the most influential predictor of second fill, with larger effect sizes than other factors even for patients with minimal or intermittent opioid use. Increasing preoperative use was associated with risk-adjusted likelihood of requiring a second opioid fill compared to naïve patients (minimal use: