Variations in postoperative opioid prescribing by day of week and duration of hospital stay

Lazar, Damien J.; Zaveri, Shruti; Khetan, Prerna; Nobel, Tamar; Divino, Celia M.

doi:10.1016/j.surg.2020.05.047

Cited by 9 publications

(4 citation statements)

References 27 publications

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“…Compared to those aged <31, adults aged 31–50 had a 15% higher odds ratio of being prescribed an opioid after injury, but at lower doses. Surgical team prescribing has been found to vary by length of stay, with longer hospitalization linked to higher doses ( 32 ). While no difference in doses were observed based on length of stay in this analysis, patients with longer hospitalizations had decreased odds ratio of receiving an opioid prescription.…”

Section: Discussionmentioning

confidence: 99%

Opioid utilization after orthopaedic trauma hospitalization among Medicaid-insured adults

Giordano,

Zhao,

Kalicheti

et al. 2024

Front. Public Health

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Opioids are vital to pain management and sedation after trauma-related hospitalization. However, there are many confounding clinical, social, and environmental factors that exacerbate pain, post-injury care needs, and receipt of opioid prescriptions following orthopaedic trauma. This retrospective study sought to characterize differences in opioid prescribing and dosing in a national Medicaid eligible sample from 2010–2018. The study population included adults, discharged after orthopaedic trauma hospitalization, and receiving an opioid prescription within 30 days of discharge. Patients were identified using the International Classification of Diseases (ICD-9; ICD-10) codes for inpatient diagnosis and procedure. Filled opioid prescriptions were identified from National Drug Codes and converted to morphine milligram equivalents (MME). Opioid receipt and dosage (e.g., morphine milligram equivalents [MME]) were examined as the main outcomes using regressions and analyzed by year, sex, race/ethnicity, residence rurality-urbanicity, and geographic region. The study population consisted of 86,091 injured Medicaid-enrolled adults; 35.3% received an opioid prescription within 30 days of discharge. Male patients (OR = 1.12, 95% CI: 1.07–1.18) and those between 31–50 years of age (OR = 1.15, 95% CI: 1.08–1.22) were found to have increased odds ratio of receiving an opioid within 30 days of discharge, compared to female and younger patients, respectively. Patients with disabilities (OR = 0.75, 95% CI: 0.71–0.80), prolonged hospitalizations, and both Black (OR = 0.87, 95% CI: 0.83–0.92) and Hispanic patients (OR = 0.72, 95% CI: 0.66–0.77), relative to white patients, had lower odds ratio of receiving an opioid prescription following trauma. Additionally, Black and Hispanic patients received lower prescription doses compared to white patients. Individuals hospitalized in the Southeastern United States and those between the ages of 51–65 age group were found to be prescribed lower average daily MME. There were significant variations in opioid prescribing practices by race, sex, and region. National guidelines for use of opioids and other pain management interventions in adults after trauma hospitalization may help limit practice variation and reduce implicit bias and potential harms in outpatient opioid usage.

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Section: Discussionmentioning

confidence: 99%

Opioid utilization after orthopaedic trauma hospitalization among Medicaid-insured adults

Giordano,

Zhao,

Kalicheti

et al. 2024

Front. Public Health

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“…For example, it has been previously demonstrated that operative time and case complexity is associated with postoperative opioid prescription size. 7,42 Therefore, low case complexity, short incision length, or patient preference to avoid opioids may explain why patients who did not receive a prescription had less pain overall. Conversely, patients undergoing longer, more complex operations may both have more pain and be more likely to receive a larger prescription.…”

Section: Discussionmentioning

confidence: 99%

The Association of Postoperative Opioid Prescriptions with Patient Outcomes

Howard

Brown

Lai³

et al. 2021

Annals of Surgery

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To compare outcomes after surgery between patients who were not prescribed opioids and patients who were prescribed opioids. Summary of Background Data: Postoperative opioid prescriptions carry significant risks. Understanding outcomes among patients who receive no opioids after surgery may inform efforts to reduce these risks. Methods: We performed a retrospective study of adult patients who underwent surgery between January 1, 2019 and October 31, 2019. The primary outcome was the composite incidence of an emergency department visit, readmission, or reoperation within 30 days of surgery. Secondary outcomes were postoperative pain, satisfaction, quality of life, and regret collected via postoperative survey. A multilevel, mixed-effects logistic regression was performed to evaluate differences between groups. Results: In a cohort of 22,345 patients, mean age (standard deviation) was 52.1 (16.5) years and 13,269 (59.4%) patients were female. About 3175 (14.2%) patients were not prescribed opioids, of whom 422 (13.3%) met the composite adverse event endpoint compared to 2255 (11.8%) of patients not prescribed opioids (P = 0.015). Patients not prescribed opioids had a similar probability of adverse events {11.7% [95% confidence interval (CI) 10.2%−13.2%] vs 11.9% (95% CI 10.6%-13.3%]}. Among 12,872 survey respondents, patients who were not prescribed an opioid had a similar rate of high satisfaction [81.7% (95% CI 77.3%-86.1%) vs 81.7% (95% CI 77.7%-85.7%)] and no regret [(93.0% (95% CI 90.8%-95.2%) vs 92.6% (95% CI 90.4%-94.7%)].Conclusions: Patients who were not prescribed opioids after surgery had similar clinical and patient-reported outcomes as patients who were prescribed opioids. This suggests that minimizing opioids as part of routine postoperative care is unlikely to adversely affect patients.

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“…Prior studies on disparities in postoperative opioid prescribing have focused primarily on in-hospital opioid administration or long-term opioid use (28,29). Fewer studies in this setting have examined discharge opioid prescribing for adults, and none have looked across different surgical subspecialties or service lines (24,30,31).…”

Section: Introductionmentioning

confidence: 99%

Disparities in Postoperative Opioid Prescribing by Race and Ethnicity: An Electronic Health Records-Based Observational Study

Romanelli

Shenoy

Martinez

et al. 2023

Preprint

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Background: Prior studies on disparities in postoperative opioid prescribing have focused primarily on in-hospital opioid administration or long-term opioid use, with fewer studies examining discharge opioid prescribing for adults, and no studies looking across different surgical subspecialties or service lines. We sought to examine racial and ethnic disparities in postoperative opioid prescribing to test the hypothesis that racial and ethnic minority groups receive opioid prescriptions at postoperative discharge with lower morphine milligram equivalents (MME) than non-Hispanic whites (NHW). Methods: We utilized electronic health records (EHR) data across 24 hospitals from a healthcare delivery system in northern California from January 1, 2015 to February 2, 2020 (study period). The sample included adult patients undergoing a procedure during the study period, discharged to home with an opioid prescription. Cross-sectional, secondary data analyses were conducted to examine differences by race and ethnicity in opioid prescribing, measured as MME, among patients who underwent select, but commonly performed, surgical procedures. Linear regression models included adjustment for factors that would likely influence prescribing decisions and race and ethnicity-specific propensity weights. Opioid prescribing, overall and by race and ethnicity, was also compared to postoperative opioid guidelines. Results: Among 61,564 patients, on adjusted regression analysis, non-Hispanic Black (NHB) patients received prescriptions with higher mean MME than NHW patients (+6.4% [95% confidence interval: 4.4%, 8.3%]), whereas Hispanic and non-Hispanic Asian patients received lower mean MME (-4.2% [-5.1%, -3.2%] and -3.6% [-4.8%, -2.3%], respectively). Nevertheless, 72.8% of all patients received prescriptions above guidelines, ranging from 71.0% to 80.3% by race and ethnicity. Disparities in prescribing were eliminated among Hispanic and NHB patients versus NHW patients when prescriptions were written within guideline recommendations. Conclusions: Racial and ethnic disparities in opioid prescribing exist in the postoperative setting, yet all groups received prescriptions above guideline recommendations. Policies encouraging guideline-based postoperative prescribing can reduce disparities and overall excess prescribing.

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Variations in postoperative opioid prescribing by day of week and duration of hospital stay

Cited by 9 publications

References 27 publications

Opioid utilization after orthopaedic trauma hospitalization among Medicaid-insured adults

Opioid utilization after orthopaedic trauma hospitalization among Medicaid-insured adults

The Association of Postoperative Opioid Prescriptions with Patient Outcomes

Disparities in Postoperative Opioid Prescribing by Race and Ethnicity: An Electronic Health Records-Based Observational Study

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