Persistent Opioid Use After Cardiac Implantable Electronic Device Procedures

Background: Prescription opioids are a major contributor to the ongoing epidemic of persistent opioid use (POU). The incidence of POU among opioid-naïve patients after cardiac implantable electronic device (CIED) procedures is unknown. Methods: This retrospective cohort study used data from a national administrative claims database from 2004 to 2018 of patients undergoing CIED procedures. Adult patients were included if they were opioid-naïve during the 180-day period before the procedure and did not undergo another procedure with anesthesia in the next 180 days. POU was defined by filling an additional opioid prescription >30 days after the CIED procedure. Results: Of the 143 400 patients who met the inclusion criteria, 15 316 (11%) filled an opioid prescription within 14 days of surgery. Among these patients, POU occurred in 1901 (12.4%) patients 30 to 180 days after surgery. The likelihood of developing POU was increased for patients who had a history of drug abuse (odds ratio, 1.52; P =0.005), preoperative muscle relaxant (odds ratio, 1.52; P <0.001) or benzodiazepine (odds ratio, 1.23; P =0.001) use, or opioid use in the previous 5 years (OR, 1.76; P <0.0001). POU did not differ after subcutaneous implantable cardioverter defibrillator or other CIED procedures (11.1 versus 12.4%; P =0.5). In a sensitivity analysis excluding high-risk patients who were discharged to a facility or who had a history of drug abuse or previous opioid, benzodiazepine, or muscle relaxant use, 8.9% of the remaining cohort had POU. Patients prescribed >135 mg of oral morphine equivalents had a significantly increased risk of POU. Conclusions: POU is common after CIED procedures, and 12% of patients continued to use opioids >30 days after surgery. Higher initially prescribed oral morphine equivalent doses were associated with developing POU.

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Elective Shoulder Surgery in the Opioid Naïve: Rates of and Risk Factors for Long-term Postoperative Opioid Use

The American Journal of Sports Medicine ◽

10.1177/0363546519837516 ◽

2019 ◽

Vol 47 (5) ◽

pp. 1051-1056 ◽

Cited By ~ 17

Author(s):

Timothy S. Leroux ◽

Bryan M. Saltzman ◽

Shelby A. Sumner ◽

Naomi Maldonado-Rodriguez ◽

Avinesh Agarwalla ◽

...

Keyword(s):

Risk Factors ◽

Shoulder Surgery ◽

Labral Repair ◽

Administrative Claims ◽

Opioid Use ◽

Level Of Evidence ◽

Opioid Prescription ◽

Prescription Refill ◽

History Of

Background: Little is known regarding the rates and risk factors for long-term postoperative opioid use among opioid-naïve patients undergoing elective shoulder surgery. Purpose: To identify (1) the proportion of opioid-naïve patients undergoing elective shoulder surgery, (2) the rates of postoperative opioid use among these patients, and (3) the risk factors associated with long-term postoperative opioid use. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective review of a private administrative claims database was performed to identify those individuals who underwent elective shoulder surgery between 2007 and 2015. “Opioid-naïve” patients were identified as those patients who had not filled an opioid prescription in the 180 days before the index surgery. Within this subgroup, we tracked postoperative opioid prescription refill rates and used a logistic regression to identify patient variables that were predictive for long-term opioid use, which we defined as continued opioid refills beyond 180 days after surgery. Results were reported as odds ratios (ORs). Results: Over the study period, 79,287 patients were identified who underwent elective shoulder surgery, of whom 79.5% were opioid naïve. Among opioid-naïve patients, the rate of postoperative opioid use declined over time, and 14.6% of patients were still using opioids beyond 180 days. The greatest proportion of opioid-naïve patients still filling opioid prescriptions beyond 180 days postoperatively was seen after open rotator cuff repair (20.9%), whereas arthroscopic labral repair had the lowest proportion (9.8%). Overall, a history of alcohol abuse (OR 1.56), a history of depression (OR 1.46), a history of anxiety (OR, 1.31), female sex (OR, 1.11), and higher Charlson Comorbidity Index (OR 1.02) had the most significant influence on the risk for long-term opioid use among opioid naïve patients. Conclusions: Most patients were opioid naïve before elective shoulder surgery; however, among opioid-naïve patients, 1 in 7 patients were still using opioids beyond 180 days after surgery. Among all variables, a history of mental illness most significantly increased the risk of long-term opioid use after elective shoulder surgery.

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Risk of Prolonged Opioid Use Among Opioid-Naïve Patients After Common Shoulder Arthroscopy Procedures

The American Journal of Sports Medicine ◽

10.1177/0363546518819780 ◽

2019 ◽

Vol 47 (5) ◽

pp. 1043-1050 ◽

Cited By ~ 27

Author(s):

Joseph A. Gil ◽

Vidhya Gunaseelan ◽

Steven F. DeFroda ◽

Chad M. Brummett ◽

Asheesh Bedi ◽

...

Keyword(s):

Early Recognition ◽

Shoulder Arthroscopy ◽

Oral Morphine ◽

Early Postoperative Period ◽

Opioid Use ◽

Multivariable Logistic Regression Model ◽

Level Of Evidence ◽

Opioid Prescription ◽

Opioid Dose ◽

History Of

Background: Opioid-related morbidity and mortality are major public health concerns, and the risk of long-term opioid use after shoulder arthroscopy is not well defined. Hypothesis: Substance abuse disorders, pain disorders, and psychiatric conditions increase the risk for prolonged opioid use. Study Design: Case-control study, Level of evidence, 3. Methods: Insurance claims data from the Truven Health MarketScan Research Databases was used to identify patients who underwent shoulder arthroscopy between January 1, 2010, and March 31, 2015. Opioid-naïve patients were included. New prolonged opioid use was defined as continued opioid use between 91 and 180 days after the index procedure. The authors used a multivariable logistic regression model to identify patient factors associated with the risk of new prolonged opioid use. Results: In this cohort of 104,154 opioid-naïve adult patients, 8686 (8.3%) developed new prolonged opioid use as defined in this study. A total of 31,768 (30.5%) filled an opioid prescription in the 30 days before surgery. Patients who had 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%). Patient characteristics associated with the highest odds ratios (ORs) of prolonged opioid use included those who had a total opioid dose during the perioperative period that was ≥743 oral morphine equivalents (ie, at least 149 tablets of 5-mg hydrocodone) (OR, 2.0; 95% CI, 1.9-2.1), followed by patients with a suicide and self-harm disorder (OR, 2.0; 95% CI, 1.1-3.4), a 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), an opioid prescription filled in the 30 days before surgery (OR, 1.3; 95% CI, 1.2-1.4), female sex (OR, 1.3; 95% CI, 1.2-1.3), an anxiety disorder (OR, 1.2; 95% CI, 1.1-1.3), and a history of a pain diagnosis (OR, 1.2; 95% CI, 1.1-1.2). Conclusion: The risk of prolonged opioid use after arthroscopic shoulder procedures is 8.3%, and it is higher among women and among those with greater opioid use in the early postoperative period, mental health conditions, substance dependence and abuse, and preexisting pain disorders. Patients at high risk warrant close surveillance after surgery for early recognition and management.

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Patterns of Long-Term Prescription Opioid Use Among Older Adults in the United States: A Study of Medicare Administrative Claims Data

January 2018 - Pain Physician ◽

10.36076/ppj.2021.24.31-40 ◽

2020 ◽

Vol 1;24 (1;1) ◽

pp. 31-40

Keyword(s):

Older Adults ◽

Claims Data ◽

The United States ◽

Prescription Opioid ◽

Administrative Claims ◽

Medicare Beneficiaries ◽

Opioid Use ◽

Opioid Prescription ◽

Administrative Claims Data

BACKGROUND: Long-term opioid therapy was prescribed with increasing frequency over the past decade. However, factors surrounding long-term use of opioids in older adults remains poorly understood, probably because older people are not at the center stage of the national opioid crisis. OBJECTIVES: To estimate the annual utilization and trends in long-term opioid use among older adults in the United States. STUDY DESIGN: Retrospective cohort study. SETTING: Data from Medicare-enrolled older adults. METHODS: This study utilized a nationally representative sample of Medicare administrative claims data from the years 2012 to 2016 containing records of health care services for more than 2.3 million Medicare beneficiaries each year. Medicare beneficiaries who were 65 years of age or older and who were enrolled in Medicare Parts A, B, and D, but not Part C, for at least 10 months in a year were included in the study. We measured annual utilization and trends in new long-term opioid use episodes over 4 years (2013–2016). We examined claims records for the demographic characteristics of the eligible individuals and for the presence of chronic non-cancer pain (CNCP), cancer, and other comorbidities. RESULTS: From 2013 to 2016, administrative claims of approximately 2.3 million elderly Medicare beneficiaries were analyzed in each year with a majority of them being women (~56%) and white (~82%) with a mean age of approximately 75 years. The proportion of all eligible beneficiaries with at least one new opioid prescription increased from 6.64% in 2013, peaked at 10.32% in 2015, and then decreased to 8.14% in 2016. The proportion of individuals with long-term opioid use among those with a new opioid prescription was 12.40% in 2013 and 10.20% in 2016. Among new long-term opioid users, the proportion of beneficiaries with a cancer diagnosis during the study years increased from 13.30% in 2013 to 15.67% in 2016, and the proportion with CNCP decreased from 30.25% in 2013 to 27.36% in 2016. Across all years, long-term opioid use was consistently high in the Southern states followed by the Midwest region. LIMITATIONS: This study used Medicare fee-for-service administrative claims data to capture prescription fill patterns, which do not allow for the capture of individuals enrolled in Medicare Advantage plans, cash prescriptions, or for the evaluation of appropriateness of prescribing, or the actual use of medication. This study only examined long-term use episodes among patients who were defined as opioid-naive. Finally, estimates captured for 2016 could only utilize data from 9 months of the year to capture 90-day long-term-use episodes. CONCLUSIONS: Using a national sample of elderly Medicare beneficiaries, we observed that from 2013 to 2016 the use of new prescription opioids increased from 2013 to 2014 and peaked in 2015. The use of new long-term prescription opioids peaked in 2014 and started to decrease from 2015 and 2016. Future research needs to evaluate the impact of the changes in new and long-term prescription opioid use on population health outcomes. KEY WORDS: Long-term, opioids, older adults, trends, Medicare, chronic non-cancer pain, cancer, cohort study

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Postoperative Pain Control Following Cardiac Implantable Electronic Device Implantation

10.5772/intechopen.101517 ◽

2021 ◽

Author(s):

Peter Magnusson ◽

Jo Ann LeQuang ◽

Joseph V. Pergolizzi

Keyword(s):

Postoperative Pain ◽

Pain Control ◽

Electronic Device ◽

Perioperative Period ◽

Cardiac Implantable Electronic Device ◽

Opioid Use ◽

Acute Postoperative Pain ◽

Device Implantation ◽

Analgesic Regimen ◽

Short Course

Postoperative pain following cardiac implantable electronic device (CIED) surgery may not always be adequately treated. The postoperative pain trajectory occurs over several days following the procedure with tenderness and limited arm range of motion lasting for weeks after surgery. Pain control typically commences in the perioperative period while the patient is in the hospital and may continue after discharge; outpatients may be given a prescription and advice for their analgesic regimen. It is not unusual for CIED patients to be discharged a few hours after implantation. While opioids are known as an effective analgesic to manage acute postoperative pain, growing scrutiny on opioid use as well as their side effects and potential risks have limited their use. Opioids may be considered for appropriate patients for a short course of treatment of acute postoperative pain, but other analgesics may likewise be considered.

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Prolonged Postoperative Opioid Use After Arthroscopic Femoroacetabular Impingement Syndrome Surgery: Predictors and Outcomes at Minimum 2-Year Follow-up

Orthopaedic Journal of Sports Medicine ◽

10.1177/23259671211038933 ◽

2021 ◽

Vol 9 (11) ◽

pp. 232596712110389

Author(s):

Edward C. Beck ◽

Benedict U. Nwachukwu ◽

Justin Drager ◽

Kyleen Jan ◽

Jonathan Rasio ◽

...

Keyword(s):

Confidence Interval ◽

Femoroacetabular Impingement ◽

Hip Arthroscopy ◽

Odds Ratio ◽

Impingement Syndrome ◽

Opioid Use ◽

Opioid Prescription ◽

Femoroacetabular Impingement Syndrome ◽

Prescription Refill

Background: The association between prolonged postoperative opioid use on outcomes after hip preservation surgery is not known. Purpose: To compare minimum 2-year patient-reported outcomes (PROs) between patients who required ≥1 postoperative opioid refill after undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS) versus patients who did not require a refill and to identify preoperative predictors for patients requiring ≥1 postoperative opioid refill. Study Design: Cohort study; Level of evidence, 3. Methods: Data from consecutive patients who underwent arthroscopic surgery for FAIS between January 2012 and January 2017 were analyzed. Multivariate regression analysis was performed to classify patient and radiographic variables as predictive of requiring ≥1 opioid prescription refill after surgery. Patients completed the following PROs preoperatively and at 2-year follow-up: Hip Outcome Score— Activities of Daily Living subscale (HOS-ADL), HOS–Sports Subscale (HOS-SS), modified Harris Hip Score (mHHS), International Hip Outcome Tool (iHOT-12), and 100-point visual analog scale (VAS) for pain and satisfaction. Scores were compared between patients needing additional prescription opioids and those who did not. Results: A total of 775 patients, of whom 141 (18.2%) required ≥1 opioid prescription refill, were included in the analysis. Patients requiring opioid refills had significantly lower 2-year postoperative PRO scores compared with patients not requiring refills: HOS-ADL (79.9 ± 20.3 vs 88.7 ± 14.9), HOS-SS (64.6 ± 29.5 vs 78.2 ± 23.7), mHHS (74.2 ± 21.1 vs 83.6 ± 15.9), iHOT-12 (63.6 ± 27.9 vs 74.9 ± 24.8), and VAS satisfaction (73.4 ± 30.3 vs 82.2 ± 24.9), as well as significantly more pain (26.8 ± 23.4 vs 17.9 ± 21.8) ( P ≤ .001 for all). Predictors of requiring a postoperative opioid refill included patients with active preoperative opioid use (odds ratio, 3.12 [95% confidence interval, 1.06-9.21]; P = .039) and larger preoperative alpha angles (odds ratio, 1.04 [95% confidence interval, 1.01-1.07]; P = .03). Conclusion: Patients requiring ≥1 opioid prescription refill after hip arthroscopy for FAIS had lower preoperative and 2-year PRO scores when compared with patients not requiring refills. Additionally, active opioid use at the time of surgery was found to be predictive of requiring additional opioids for pain management.

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Patient and Procedural Determinants of Postoperative Pain Trajectories

Anesthesiology ◽

10.1097/aln.0000000000003681 ◽

2021 ◽

Vol 134 (3) ◽

pp. 421-434

Author(s):

Terrie Vasilopoulos ◽

Richa Wardhan ◽

Parisa Rashidi ◽

Roger B. Fillingim ◽

Margaret R. Wallace ◽

...

Keyword(s):

Postoperative Pain ◽

Odds Ratio ◽

Multivariable Analysis ◽

Oral Morphine ◽

Surgical Patient ◽

Opioid Use ◽

Acute Postoperative Pain ◽

Patient Factors ◽

Pain Group ◽

Pain Trajectories

Background The primary goal of this study was to evaluate patterns in acute postoperative pain in a mixed surgical patient cohort with the hypothesis that there would be heterogeneity in these patterns. Methods This study included 360 patients from a mixed surgical cohort whose pain was measured across postoperative days 1 through 7. Pain was characterized using the Brief Pain Inventory. Primary analysis used group-based trajectory modeling to estimate trajectories/patterns of postoperative pain. Secondary analysis examined associations between sociodemographic, clinical, and behavioral patient factors and pain trajectories. Results Five distinct postoperative pain trajectories were identified. Many patients (167 of 360, 46%) were in the moderate-to-high pain group, followed by the moderate-to-low (88 of 360, 24%), high (58 of 360, 17%), low (25 of 360, 7%), and decreasing (21 of 360, 6%) pain groups. Lower age (odds ratio, 0.94; 95% CI, 0.91 to 0.99), female sex (odds ratio, 6.5; 95% CI, 1.49 to 15.6), higher anxiety (odds ratio, 1.08; 95% CI, 1.01 to 1.14), and more pain behaviors (odds ratio, 1.10; 95% CI, 1.02 to 1.18) were related to increased likelihood of being in the high pain trajectory in multivariable analysis. Preoperative and intraoperative opioids were not associated with postoperative pain trajectories. Pain trajectory group was, however, associated with postoperative opioid use (P < 0.001), with the high pain group (249.5 oral morphine milligram equivalents) requiring four times more opioids than the low pain group (60.0 oral morphine milligram equivalents). Conclusions There are multiple distinct acute postoperative pain intensity trajectories, with 63% of patients reporting stable and sustained high or moderate-to-high pain over the first 7 days after surgery. These postoperative pain trajectories were predominantly defined by patient factors and not surgical factors. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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Persistent opioid use after radiation therapy in opioid-naive cervical cancer survivors

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2019-000430 ◽

2019 ◽

Vol 29 (7) ◽

pp. 1105-1109 ◽

Cited By ~ 1

Author(s):

Kelsey Ward ◽

Amin Ramzan ◽

Jeanelle Sheeder ◽

Stacy Fischer ◽

Carolyn Lefkowits

Keyword(s):

Cervical Cancer ◽

Substance Abuse ◽

Cancer Survivors ◽

Multivariable Analysis ◽

Figo Stage ◽

Opioid Use ◽

Opioid Prescription ◽

Gynecology And Obstetrics ◽

History Of ◽

Disease Free

ObjectivesOpioids are first-line therapy for cancer-related pain, but their use should be minimized in disease-free survivors. We sought to describe rates and identify predictors of persistent opioid use among previously opioid-naive cervical cancer survivors treated with radiation.MethodsOpioid-naive cervical cancer patients treated primarily with radiation and chemosensitization at a single institution, between January 2011 and December 2015, were identified. Charts were reviewed for demographics, disease, and treatment characteristics, and opioid prescriptions. Primary outcome was persistent opioid use, defined as continued opioid prescription use, 6 months after radiation; patients recurring within 6 months were excluded. Groups were compared using χ2 or Fisher’s exact test. Multivariable logistic regression identified predictors of persistent opioid use.ResultsA total of 96 patients were included, with a median age of 49 years (range 27–84). Most patients (59%) at diagnosis had International Federation of Gynecology and Obstetrics (FIGO) stage I or II cervical cancer. The most common histology was squamous cell carcinoma (72%) and most (94.7%) patients received radiation with chemosensitization. Rates of persistent opioid use at 3 and 6 months after treatment were 29% and 25%, respectively. Persistent users were more likely to be <40 years old, have disease outside the pelvis at diagnosis, and have had a history of substance abuse, depression or anxiety (p<0.05). In multivariable analysis, a history of substance abuse (adjusted OR 6.21, 95% CI 1.08 to 35.67) and depression or anxiety (aOR 6.28, 95% CI 1.70 to 23.30) were independently associated with persistent opioid use.ConclusionOur study showed that 25% of patients with cervical cancer were still using opioids 6 months after radiation. History of substance abuse and depression or anxiety, all known risk factors for opioid misuse, were associated with persistent use. The goal in the disease-free survivor population should be opioid independence.

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Pre-operative opioid use in gynecologic oncology: a common comorbidity relevant to the peri-operative period

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2019-000508 ◽

2019 ◽

Vol 29 (9) ◽

pp. 1411-1416

Author(s):

Megan Elizabeth Ross ◽

Lindsay J Wheeler ◽

Dina M Flink ◽

Carolyn Lefkowits

Keyword(s):

Length Of Stay ◽

Gynecologic Oncology ◽

Oral Morphine ◽

Opioid Use ◽

Oncology Patients ◽

Opioid Prescription ◽

Operative Outcomes ◽

Operative Planning ◽

Opioid Users ◽

The Relationship

ObjectivesPre-operative opioid use is common and should be considered a comorbidity among surgical candidates. Our objective was to describe the rate of pre-operative opioid use and patterns of post-operative outpatient opioid prescribing in a cohort of gynecologic oncology patients.MethodsA retrospective cohort study was conducted with 448 gynecologic oncology surgical patients undergoing surgery for a suspected or known cancer diagnosis from January 2016 to December 2016. Pre-operative opioid users (n=97) were identified. Patient and surgical characteristics were abstracted, as was post-operative opioid prescription (type of opioid, oral morphine equivalents amount) and length of stay. For pre-operative opioid users, the type of opioid prescribed post-operatively was compared with the type of pre-operative opioid. Pre-operative opioid users were compared with non-users, stratified by surgery type. Descriptive statistics were analyzed using χ2 statistic, and medians were compared using a Mann-Whitney U statistic.ResultsPre-operative opioid prescriptions were noted in 21% of patients, and 24% of these had two or more opioid prescriptions before surgery. The majority of pre-operative opioid users (51%) were maintained on the same agent post-operatively at the time of discharge, but 36% were switched to a different opioid and 7% were prescribed an additional opioid. Overall and in laparotomies, pre-operative opioid users received higher volume post-operative prescriptions than non-users. There was no difference in post-operative prescription volume for minimally invasive surgeries or in length of stay between pre-operative users and non-users.ConclusionsPre-operative opioid use is common in gynecologic oncology patients and should be considered during pre-operative planning. Pre-operative opioid use was associated with a higher volume and wider range of post-operative prescription. Over 40% of opioid users were discharged with either an additional opioid or a new opioid, highlighting a potential missed opportunity to optimize opioid safety. Further research is needed to characterize the relationship between pre-operative opioid use and peri-operative outcomes and to develop strategies to manage pain effectively in this population without compromising opioid safety.

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Patients With Opioid Use Disorder Have Increased Readmission Rates, Emergency Room Visits, and Costs Following a Hallux Valgus Procedure

Foot & Ankle Specialist ◽

10.1177/1938640020950105 ◽

2020 ◽

pp. 193864002095010

Author(s):

James M. Parrish ◽

Rushabh M. Vakharia ◽

Dillon C. Benson ◽

Aaron K. Hoyt ◽

Nathaniel W. Jenkins ◽

...

Keyword(s):

Emergency Room ◽

Hallux Valgus ◽

Opioid Use Disorder ◽

P Value ◽

Administrative Claims ◽

Opioid Use ◽

Readmission Rates ◽

Episode Of Care ◽

History Of ◽

Care Costs

Background Patients with a history of opioid use disorder (OUD) tend to have more complications, higher readmission rates, and increased costs following orthopaedic procedures. This study evaluated patients undergoing hallux valgus correction for their odds of increased (1) readmission rates, (2) emergency room (ER) visits, and (3) costs. Methods Patients undergoing hallux valgus corrections with OUD history were identified using a national Medicare administrative claims database of approximately 24 million orthopaedic surgery patients. OUD patients were matched to non–opioid use disorder (NUD) patients in a 1:4 ratio by age, sex, Elixhauser-Comorbidity Index (ECI), diabetes mellitus, hyperlipidemia, hypertension, and tobacco use. The query yielded 6318 patients (OUD = 1276; NUD = 5042) who underwent a hallux valgus correction. Primary outcomes analyzed included odds of 90-day readmission rates, 30-day ER visits, and 90-day episode-of-care costs. Demographics, odds ratios (ORs), ECI, and cost were assessed as appropriate using a Pearson χ2 test, logistic regression, and a t test. A P value <.05 was considered statistically significant. Results There were no significant differences in demographics between OUD and NUD patients. OUD patients had higher incidence and odds of 90-day readmission (9.56% vs 6.04%; OR = 1.55; P < .001) and 30-day ER visits (0.86% vs 0.35%; OR = 2.42; P = .021) and incurred greater 90-day episode-of-care costs ($7208.28 vs $6134.75; P < .001) compared with NUD patient controls. Conclusion The study demonstrates the possible influence of OUD on higher odds of readmission, ER visits, and costs following a hallux valgus correction. Levels of Evidence Level III: Retrospective cohort study

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Persistent Opioid Use Among Pediatric Patients After Surgery

10.1542/9781610022798-persistent ◽

2018 ◽

pp. 60-68

Author(s):

Calista M. Harbaugh ◽

Jay S. Lee ◽

Hsou Mei Hu ◽

Sean Esteban McCabe ◽

Terri Voepel-Lewis ◽

...

Keyword(s):

Young Adults ◽

Confidence Interval ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Adolescents And Young Adults ◽

Opioid Misuse ◽

Opioid Use ◽

Eligibility Criteria ◽

Opioid Prescription ◽

Nonsurgical Patients

BACKGROUND Despite efforts to reduce nonmedical opioid misuse, little is known about the development of persistent opioid use after surgery among adolescents and young adults. We hypothesized that there is an increased incidence of prolonged opioid refills among adolescents and young adults who received prescription opioids after surgery compared with nonsurgical patients. METHODS We performed a retrospective cohort study by using commercial claims from the Truven Health Marketscan research databases from January 1, 2010, to December 31, 2014. We included opioid-naïve patients ages 13 to 21 years who underwent 1 of 13 operations. A random sample of 3% of nonsurgical patients who matched eligibility criteria was included as a comparison. Our primary outcome was persistent opioid use, which was defined as ≥1 opioid prescription refill between 90 and 180 days after the surgical procedure. RESULTS Among eligible patients, 60.5% filled a postoperative opioid prescription (88 637 patients). Persistent opioid use was found in 4.8% of patients (2.7%–15.2% across procedures) compared with 0.1% of those in the nonsurgical group. Cholecystectomy (adjusted odds ratio 1.13; 95% confidence interval, 1.00–1.26) and colectomy (adjusted odds ratio 2.33; 95% confidence interval, 1.01–5.34) were associated with the highest risk of persistent opioid use. Independent risk factors included older age, female sex, previous substance use disorder, chronic pain, and preoperative opioid fill. CONCLUSIONS Persistent opioid use after surgery is a concern among adolescents and young adults and may represent an important pathway to prescription opioid misuse. Identifying safe, evidence-based practices for pain management is a top priority, particularly among at-risk patients.

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