Classifying Preoperative Opioid Use for Surgical Care

Abstract

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:

Association of State Opioid Duration Limits With Postoperative Opioid Prescribing

“…As such, prescribing restrictions based on number of days alone or number of doses may miss important nuances of perioperative care, such as prior opioid exposure, procedure type, and patient-level risk factors. 24 An alternative approach to reduce excessive prescribing may be to develop and implement evidence-based prescribing guidelines based on patient-reported opioid-related outcomes, including opioid consumption, use of opioid alternatives, pain, and satisfaction. 3,[16][17][18] For example, Hill et al 17 developed opioid prescribing guidelines based on the amount consumed while being an inpatient to direct the amount prescribed for outpatient pain control after surgery.…”

Association between insurance cost-sharing subsidy and postoperative opioid prescription refills among Medicare patients

“…The secondary outcome was the odds of an initial fill, defined as filling a postoperative opioid prescription between 14 days before admission and 3 days after discharge. [19][20][21][22][23] Opioid prescription fills and refills were identified in Medicare Part D Prescription Drug Event data using National Drug Codes and converted to oral morphine equivalents using Centers for Disease Control conversion factors. 24…”

“…Patients who filled prescriptions within the period between 12 months and 15 days before admission but did not meet the criteria of chronic user were classified as intermittent opioid users. 19 The initial postoperative opioid prescription size, in 10 tablets of 5 mg oxycodone, was also included as a covariate.…”

2020 Clinical Update in Liver Transplantation

“… 69 Opioid prescribing has increased significantly and excessive opioid prescribing is prevalent, particularly after surgical care. 70 Liver transplant patients represent a population vulnerable to opioid exposure given the prevalence of substance use disorders and the associated risk of opioid misuse. 71 Indeed, a recent review of opioid use while on the transplant waiting list and following transplant revealed concerning trends.…”