Provider Characteristics Associated With Outpatient Opioid Prescribing After Surgery

Abstract

Objective: To characterize differences in postoperative opioid prescribing across surgical, nonsurgical, and advanced practice providers. Background: There is a critical need to identify best practices around perioperative opioid prescribing. To date, differences in postoperative prescribing among providers are poorly understood. Methods: This is a retrospective multi-center analysis of commercial insurance claims from a statewide quality collaborative. We identified 15,657 opioid-naïve patients who underwent a range of surgical procedures between January 2012 and October 2015 and filled an opioid prescription within 30 days postoperatively. Our primary outcome was total amount of opioid filled per prescription within 30 days postoperatively (in oral morphine equivalents [OME]). Hierarchical linear regression was used to determine the association between provider characteristics (specialty, advanced practice providers [nurse practitioners and physician assistants] vs. physician, and gender) and outcome while adjusting for patient factors. Results: Average postoperative opioid prescription amount was 326 ± 285 OME (equivalent: 65 tablets of 5 mg hydrocodone). Advanced practice providers accounted for 19% of all prescriptions, and amount per prescription was 18% larger in this group compared to physicians (315 vs. 268, P<0.001). Primary care providers accounted for 13% of all prescriptions and prescribed on average 279 OME per prescription. The amount of opioid prescribed varied by surgical specialty and ranged from 178 OME (urology) to 454 OME (neurosurgery).

Educating surgical oncology providers on perioperative opioid use: A departmental survey 1 year after the intervention

“…By targeting the correct audience, reinforcing the message with ongoing quality improvement, and clinical trial projects in the intervening year, there was successful retention of the short‐term momentum seen in the 1‐month surveys. Interestingly, APPs were identified in the pre‐education survey as a subset of providers who perceived patients to need more opioids (when compared to fellows and attendings), corroborating our own study from 2018 and the Michigan statewide collaborative in 2020 8,16 . Through the initial education, even with admittedly limited buy‐in initially, APP perceptions of patient opioids needs dramatically changed over the first month and further in the intervening year as support increased.…”

The Surgeon's Role in the Opioid Crisis: A Narrative Review and Call to Action

“…Preoperative opioid use has also been linked to poorer outcomes across most major surgical specialties (23)(24)(25)(26)(27)(28)(29)(30). These adverse outcomes have been widely documented using measures such as length of stay (27,30), readmission rate (23,27,28), postoperative cost of care (24,25,31), and complication rate (25). Among orthopedic patient populations, who often have high rates of use prior to surgery (32), preoperative opioid abuse and dependence is associated with significant increases in morbidity and mortality after surgery (33).…”

Association of State Opioid Duration Limits With Postoperative Opioid Prescribing

“…Covariates also included whether the surgery was major or minor, classifications that were made based on prior literature. 11,13,14 The Agency for Healthcare Research and Quality's Clinical Classification Software was used to create indicators for mental health diagnoses. The subcategories of the mental health diagnoses by the Clinical Classification Software were mood disorders (ie, adjustment, anxiety, and depression), suicide, disruptive behavior disorders (ie, attention-deficit/hyperactivity disorder, conduct and disruptive behavior disorders, and impulse control disorders), personality disorders, schizophrenia, other mental disorders, and substance use disorders (ie, alcohol and other substance-related disorders).…”