Persistent Opioid Use and High-Risk Prescribing in Body Contouring Patients

Bennett, Katelyn G.; Kelley, Brian P.; Vick, Alexis D; Lee, Jay S.; Gunaseelan, Vidhya; Brummett, Chad M.; Waljee, Jennifer F.

doi:10.1097/prs.0000000000005084

Cited by 40 publications

(40 citation statements)

References 44 publications

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“…As used in prior studies, 13,[16][17][18]20,21 opioid prescriptions were attributed to surgery (eg, perioperative) if filled between 30 days before surgery and 14 days after discharge. Patients were defined as opioid-naive if no opioid prescriptions were filled between 12 months and 31 days before surgery, also consistent with prior work.…”

Section: Opioid Definitionsmentioning

confidence: 99%

“…New persistent opioid use was defined as an initial perioperative opioid prescription fill, followed by one or more subsequent opioid prescription fills 91 to 180 days after the date of surgery. This definition has been used in prior analyses 13,14,17,18,20 and captures a period during which recovery from surgery is expected to have occurred.…”

Section: Opioid Definitionsmentioning

confidence: 99%

“…13,16,17,23 Despite this association, little is known about the motivation of providers and patients surrounding this practice, which should be investigated with clinical data. Increased odds of new persistent use based on prescription size have been found after general and plastic surgery procedures with a small to moderate effect size, 13,18 with both studies dichotomizing prescription size at the 75th percentile to divide all patients into two groups by prescription size. In contrast, this relationship was not found among oncology patients 16 and was not assessed in other analyses of new persistent use.…”

Section: Commentmentioning

confidence: 99%

“…[13][14][15][16][17] Analyzing the association between prescription size and new persistent opioid use, however, has generated mixed results. Although a variable effect of prescribing greater than the 75th percentile of prescription size has been shown after general surgery 13 and plastic surgery procedures, 18 prescription size was not a predictor of new persistent use after curative-intent oncologic surgery 16 and was not evaluated in analyses of several other types of surgery. 14,15,17,19 Lung cancer surgery has been associated with a relatively high rate of new persistent opioid use, 17 Accepted for publication Jun 12, 2019. whereas new persistent use after cardiac surgery has not been defined.…”

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confidence: 99%

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Impact of Prescribing on New Persistent Opioid Use After Cardiothoracic Surgery

Brescia

Waljee

et al. 2019

The Annals of Thoracic Surgery

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Background. New persistent opioid use occurs in 3% to 14% of patients after elective surgery, but is poorly described after cardiothoracic surgery. We examined the association of prescription size with new persistent opioid use after cardiothoracic surgery. Methods. Opioid-naive Medicare patients undergoing cardiothoracic surgery between 2009 and 2015 were identified. Patients who filled an opioid prescription between 30 days before surgery and 14 days after discharge and with continuous Medicare enrollment 12 months before and 6 months after surgery were selected (n [ 24,549). New persistent use was defined as continued prescription fills 91 to 180 days after surgery. Prescription size was reported in oral morphine equivalents. Multivariable regression was performed for risk adjustment, and new persistent use rate was estimated. Results. Patient age was 71 ± 8 years, 9222 (38%) were female, and 20,898 (85%) were white. Overall new persistent use was 12.8% (3153 of 24,549), and declined yearly from 17% in 2009 to 7.1% in 2015 (P < .001). Prescription size, preoperative prescription fills, black race, gastrointestinal complications, disability status, open lung resection, dual eligibility (Medicare and Medicaid), drug and substance abuse, female sex, tobacco use, high comorbidity, pain disorders, longer hospital stay, and younger age were associated with new persistent use. Adjusted new persistent use was 19.6% (95% confidence interval, 18.7% to 20.4%) among patients prescribed more than 450 oral morphine equivalents, compared with 10.4% (95% confidence interval, 9.9% to 10.8%) among those prescribed 200 oral morphine equivalents or less (P < .001). Conclusions. Size and timing of perioperative opioid prescriptions were the strongest predictors of new persistent opioid use after cardiothoracic surgery. Modifiable risk factors such as prescription size should be targeted to reduce new persistent use.

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Section: Opioid Definitionsmentioning

confidence: 99%

Section: Opioid Definitionsmentioning

confidence: 99%

Section: Commentmentioning

confidence: 99%

mentioning

confidence: 99%

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Impact of Prescribing on New Persistent Opioid Use After Cardiothoracic Surgery

Brescia

Waljee

et al. 2019

The Annals of Thoracic Surgery

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“…(After After accounting for the duplicate studies, which appeared under various search headings, 230 distinct articles were identified. The review of the abstracts and/or full texts yielded 17 articles, which evaluated the risk of OUD from opioids administered perioperatively and were therefore retained for further analysis (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22). The excluded studies pertained to a range of topics including opioid sparing perioperative analgesic techniques, acute opioid tolerance, opioid induced hyperalgesia, perioperative use of ketamine, lidocaine and dexmedetomidine, and multimodal perioperative analgesia.…”

Section: Resultsmentioning

confidence: 99%

Risk of Opioid Use Disorder from Exposure to Opioids in the Perioperative Period: A Systematic Review

et al. 2020

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Opioid use disorder, a major source of morbidity and mortality globally, is regularly linked to opioids given around the time of surgery. Perioperative period, however, is markedly heterogeneous, with the diverse providers using opioids distinctively, and the various drivers of opioid misuse at-play dissimilarly, throughout the perioperative period. The risk of opioid use disorder may, therefore, be different from opioids given at the various phases of perioperative care, and the ensuing recommendations for their use may also be dissimilar. Systematic search and analysis of the pertinent literature, following the accepted standards, showed an overall increased risk of misuse from the perioperative opioids. However, the analyzed studies had significant methodological limitations, and were constrained mainly to the outpatient phase of the perioperative period. Lacking any data, this risk, therefore, is unknown for intraoperative and postoperative recovery periods. Consequently, no firm recommendations can be extended to anesthesia providers generally managing these perioperative stages. Furthermore, with significant methodological limitations, the current recommendations for opioid use after surgery are also arbitrary. Thus, though proposals for perioperative opioid use are formulated in this article, substantive recommendations would require clear delineation of these risks, while avoiding the limitations noted in this review.

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Rate and Risk Factors Associated With Prolonged Opioid Use After Surgery

et al. 2020

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IMPORTANCE Prolonged opioid use after surgery may be associated with opioid dependency and increased health care use. However, published studies have reported varying estimates of the magnitude of prolonged opioid use and risk factors associated with the transition of patients to longterm opioid use. OBJECTIVES To evaluate the rate and characteristics of patient-level risk factors associated with increased risk of prolonged use of opioids after surgery. DATA SOURCES For this systematic review and meta-analysis, a search of MEDLINE, Embase, and Google Scholar from inception to August 30, 2017, was performed, with an updated search performed on June 30, 2019. Key words may include opioid analgesics, general surgery, surgical procedures, persistent opioid use, and postoperative pain.STUDY SELECTION Of 7534 articles reviewed, 33 studies were included. Studies were included if they involved participants 18 years or older, evaluated opioid use 3 or more months after surgery, and reported the rate and adjusted risk factors associated with prolonged opioid use after surgery. DATA EXTRACTION AND SYNTHESISThe Meta-analysis of Observational Studies in Epidemiology (MOOSE) and Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines were followed. Two reviewers independently assessed and extracted the relevant data. MAIN OUTCOMES AND MEASURESThe weighted pooled rate and odds ratios (ORs) of risk factors were calculated using the random-effects model. RESULTSThe 33 studies included 1 922 743 individuals, with 1 854 006 (96.4%) from the US. In studies with available sex and age information, participants were mostly female (1 031 399; 82.7%) and had a mean (SD) age of 59.3 (12.8) years. The pooled rate of prolonged opioid use after surgery was 6.7% (95% CI, 4.5%-9.8%) but decreased to 1.2% (95% CI, 0.4%-3.9%) in restricted analyses involving only opioid-naive participants at baseline. The risk factors with the strongest associations with prolonged opioid use included preoperative use of opioids (OR, 5.32; 95% CI, 2.94-9.64) or illicit cocaine (OR, 4.34; 95% CI,) and a preoperative diagnosis of back pain (OR, 2.05; 95% CI, 1.63-2.58). No significant differences were observed with various study-level factors, including a comparison of major vs minor surgical procedures (pooled rate: 7.0%; 95% CI, 4.9%-9.9% vs 11.1%; 95% CI, 6.0%-19.4%; P = .20). Across all of our analyses, there was substantial variability because of heterogeneity instead of sampling error. (continued) Key Points Question What are the rate and risk factors associated with prolonged use of opioid medications after surgery? Findings In this systematic review and meta-analysis of 33 observational studies including more than 1.9 million patients, 7% of patients continued to fill opioid prescriptions more than 3 months after surgery. Preoperative use of opioids, illicit cocaine use, and pain conditions before surgery had the strongest associations with prolonged opioid use after surgery. Meaning The findings suggest that an eval...

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Persistent Opioid Use and High-Risk Prescribing in Body Contouring Patients

Cited by 40 publications

References 44 publications

Impact of Prescribing on New Persistent Opioid Use After Cardiothoracic Surgery

Impact of Prescribing on New Persistent Opioid Use After Cardiothoracic Surgery

Risk of Opioid Use Disorder from Exposure to Opioids in the Perioperative Period: A Systematic Review

Rate and Risk Factors Associated With Prolonged Opioid Use After Surgery

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