New Persistent Opioid Use and Associated Risk Factors Following Treatment of Ankle Fractures

2019 ◽  
Vol 40 (9) ◽  
pp. 1043-1051 ◽  
Author(s):  
Timothy D. Gossett ◽  
Fred T. Finney ◽  
Hsou Mei Hu ◽  
Jennifer F. Waljee ◽  
Chad M. Brummett ◽  
...  
Keyword(s):  
Risk Factors ◽  
Surgical Treatment ◽  
Ankle Fracture ◽  
Opioid Use ◽  
Patient Factors ◽  
Distal Fibula ◽  
Opioid Prescription ◽  
Opioid Dose ◽  
Closed Treatment ◽  
Open Treatment

Background:The aim of this study was to define the rate of new persistent opioid use and risk factors for persistent opioid use after operative and nonoperative treatment of ankle fractures.Methods:Using a nationwide insurance claims database, Clinformatics DataMart Database, we identified opioid-naïve patients who underwent surgical treatment of unstable ankle fracture patterns between January 2009 and June 2016. Patients who underwent closed treatment of a distal fibula fracture served as a comparative group. We evaluated peritreatment and posttreatment opioid prescription fills. The primary outcome, new persistent opioid use, was defined as opioid prescription fulfillment between 91 and 180 days after the procedure. Logistic regression was used to evaluate the effect of patient factors, and the differences of the effect were tested using Wald statistics. The adjusted persistent use rates were calculated. A total of 13 088 patients underwent treatment of an ankle fracture and filled a peritreatment opioid prescription.Results:When compared with closed treatment of a distal fibula fracture, only 2 surgical treatment subtypes demonstrated significantly increased rates of persistent use compared with the closed treatment group: open treatment of bimalleolar ankle fracture (adjusted odds ratio [aOR], 1.32; 95% CI, 1.10-1.58; P = .002) and open treatment of trimalleolar ankle fracture with fixation of posterior lip (aOR, 1.47; 95% CI, 1.04-2.07; P = .027). Rates were significantly increased (aOR, 1.56; 95% CI, 1.34-1.82; P < .001) among patients who received a total peritreatment opioid dose that was in the top 25th percentile of total oral morphine equivalents. Factors independently associated with new persistent opioid use included mental health disorders, comorbid conditions, tobacco use, and female sex.Conclusion:All ankle fracture treatment groups demonstrated high rates of new persistent opioid use, and persistent use was not directly linked to injury severity. Instead, we identified patient factors that demonstrated increased risk of persistent opioid use. Limiting the peritreatment opioid dose was the largest modifiable risk factor related to new persistent opioid use in this privately insured cohort.Level of Evidence:Level III, retrospective cohort study.

scholarly journals New Persistent Opioid Use Following Operative Treatment of Ankle Fractures Compared to Nonoperatively Treated Fractures

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0005 ◽  
Author(s):  
Timothy Gossett ◽  
Fred Finney ◽  
Paul Talusan ◽  
James Holmes
Keyword(s):  
Public Health ◽  
Household Income ◽  
Ankle Fractures ◽  
Patient Specific ◽  
Opioid Use ◽  
Distal Fibula ◽  
Opioid Prescription ◽  
Fibula Fracture ◽  
Closed Treatment ◽  
Chronic Opioid Use

Category: Trauma Introduction/Purpose: Chronic opioid use is a major public health concern in the United States. Orthopaedic surgeons prescribe 8% of narcotics in the U.S. while only comprising 2.5% of U.S. physicians. Understanding that neither the amount nor duration of opioid prescription correlates with patient satisfaction, orthopaedic surgeons have a unique opportunity to play a prominent role in the solution. In order to address and mitigate this epidemic, it is important to first understand rates of new persistent opioid use following specific orthopaedic procedures and to identify patient-specific risk factors. Methods: Using a widely accepted insurance claims database, we identified patients who underwent surgical treatment of common ankle fractures patterns (bimalleolar, trimalleolar, and isolated distal fibula) between January 2008 and December 2016. None had an opioid prescription filled in the period of 12 months to 15 days prior to treatment (defined as “opioid naïve”). Opioid naïve patients who underwent closed treatment of a distal fibula fracture served as a comparative group. We evaluated peri-treatment and post-treatment opioid prescription fulfillment. The primary outcome, new persistent opioid use, was defined as opioid prescription fulfillment between 91 and 180 days after the procedure. Logistic regression was used to evaluate the effect of patient factors, including surgery type, age, gender, median household income, mental health and pain disorders on the likelihood of new persistent use. Results: There was no significant difference in new persistent opioid use rates overall following surgical treatment of ankle fractures (8.4%) compared to closed fibula fracture treatment (7.4%), and all treatment groups demonstrated high rates of new persistent use. Two surgically treated fracture subtypes, treatment of bimalleolar ankle fractures and treatment of trimalleolar ankle fractures with fixation of posterior lip, demonstrated significantly higher new persistent opioid use rates (Figure). Rates were significantly increased among patients who received an opioid dose prescribed in the peri-treatment period that was in the top 25th percentile of total oral morphine equivalents. Patient-specific factors which were associated with new persistent opioid use included certain mental health disorders, comorbid conditions, arthritis, tobacco use, female gender, and household income greater than $100,000. Conclusion: Chronic opioid use, even in opioid naïve patients, is a major problem following orthopaedic procedures. To decrease the rate of chronic opioid use, it is important to first understand and define the rate of persistent use following these procedures. The overall new persistent opioid use following surgical fixation of ankle fractures was similar to the rate of persistent use in patients who underwent closed treatment of a fibula fracture. Understanding these high persistent use rates and the risk factors that may play a role in this problem provides a foundation upon which to address this sometimes lethal public health problem.

Risk Factors for Prolonged Opioid Use After Open Treatment of Distal Radius Fractures

Hand ◽  
2021 ◽  
pp. 155894472098810
Author(s):  
Mia M. Qin ◽  
Charles D. Qin ◽  
Chirag M. Shah
Keyword(s):  
Risk Factors ◽  
Distal Radius ◽  
Significant Risk ◽  
Distal Radius Fractures ◽  
Opioid Use ◽  
Radius Fractures ◽  
Opioid Prescription ◽  
Logistic Regression Models ◽  
Factors Associated ◽  
Open Treatment

Background The objective of this study was to evaluate factors associated with postoperative opioid use after open treatment of distal radius fractures. Methods The Humana insurance claims database was queried for open treatment of distal radius fractures by Current Procedural Terminology codes. The search was further refined to identify patients who filled an opioid prescription within 6 weeks after their surgery. The study’s outcomes were: (1) limited postoperative opioid use, defined as filling a prescription once in the 6-week to 6-month period after surgery; and (2) persistent postoperative opioid use, defined as filling a prescription more than once in the 6-week to 6-month period after surgery. Logistic regression models were performed to identify factors associated with limited and persistent postoperative opioid use. Subgroup analyses were performed among opioid-naïve patients and those with open fractures. Results This study identified 9141 of 19 220 total patients with limited and persistent opioid use. Significant risk factors included nonhome discharge, inpatient surgical setting, long-term pain, tobacco abuse, and age less than 65 years. Of note, both preoperative opioid use within 1 month before surgery (odds ratio [OR], 2.6; 95% confidence interval [CI], 2.2-2.9) and preoperative opioid use between 1 and 6 months before surgery (OR, 4.0; 95% CI, 3.7-4.4) were significantly associated with persistent postoperative opioid use. Conclusions This study has identified numerous risk factors associated with postoperative opioid use after open treatment of distal radius fractures. Understanding these risk factors is the first step toward reducing postoperative opioid use.

scholarly journals New Persistent Opioid Use Following Common Forefoot Procedures for Treatment of Hallux Valgus

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0005 ◽  
Author(s):  
Fred Finney ◽  
Timothy Gossett ◽  
David Walton ◽  
Paul Talusan ◽  
James Holmes
Keyword(s):  
Public Health ◽  
Surgical Treatment ◽  
Hallux Valgus ◽  
Metatarsal Osteotomy ◽  
Foot And Ankle ◽  
Opioid Use ◽  
Patient Factors ◽  
Opioid Prescription ◽  
Factors Associated ◽  
First Metatarsal

Category: Bunion Introduction/Purpose: Chronic opioid use and abuse is one of the greatest public health challenges in the United States and continues to worsen. Orthopaedic surgeons stand at #4 on the list of top prescribers of opioid analgesics by specialty and are squarely positioned to have an impact on the problem. A recent study revealed an 8% prevalence of new persistent opioid usage following abdominal surgery. At present, the incidence of persistent opioid use after foot and ankle surgery is largely unknown. Operative bunion correction is one of the most commonly performed elective foot and ankle surgeries in this country. We sought to determine the incidence of new persistent opioid use following surgical treatment of hallux valgus and to identify patient factors associated with persistent opioid use. Methods: A nationwide insurance claims data set from January 2010 to June 2015 was used to identify opioid naive patients (defined as patients with no prior opioid use 12 months prior to injury) who underwent surgical treatment of hallux valgus with either a proximal or distal first metatarsal osteotomy. The incidence of new persistent opioid use, defined by opioid prescription fulfillment between 90 and 180 days after surgery was then calculated. Data were assessed for patient factors which may be predictors of new persistent opioid use including surgery type, health insurance type, age, gender, household income, and comorbidities. Results: A total of 38,312 patients underwent surgical treatment of hallux valgus with either a distal or proximal first metatarsal osteotomy and filled a perioperative opioid prescription. The rate of new persistent opioid use among all patients was 5.6%. The majority of patients (90%) underwent treatment with a distal metatarsal osteotomy. Patients who underwent treatment with a proximal metatarsal osteotomy were more likely to have new persistent opioid use (aOR: 1.16; p=0.04). Logistic regression analysis demonstrated that patient factors independently associated with new persistent opioid use included depression, anxiety, alcohol and substance abuse disorders, and certain preoperative pain disorders. Age, gender, and income were not associated with new persistent opioid use. Conclusion: Despite rising national attention, opioid abuse continues to be a growing epidemic. In order for foot and ankle surgeons to help solve this problem, it must first be better defined. New persistent opioid use following surgical treatment of hallux valgus affects a substantial, growing number of patients. Fifty percent of patients using opioids for 3 months will be using them at 5 years. Understanding patient factors associated with persistent opioid use can help clinicians identify and counsel at-risk patients and ultimately focus strategies and interventions aimed at mitigating and eliminating this massive public health problem.

Association Between Opioid Use and Diabetes in Patients With Ankle Fracture Repair

2021 ◽  
pp. 107110072110581
Author(s):  
Wenye Song ◽  
Naohiro Shibuya ◽  
Daniel C. Jupiter
Keyword(s):  
Diabetes Mellitus ◽  
Logistic Regression ◽  
Ankle Fracture ◽  
Regression Models ◽  
Fracture Repair ◽  
Opioid Use ◽  
Data Set ◽  
Opioid Prescription ◽  
Logistic Regression Models ◽  
Patients With Diabetes

Background: Ankle fractures in patients with diabetes mellitus have long been recognized as a challenge to practicing clinicians. Ankle fracture patients with diabetes may experience prolonged healing, higher risk of hardware failure, an increased risk of wound dehiscence and infection, and higher pain scores pre- and postoperatively, compared to patients without diabetes. However, the duration of opioid use among this patient cohort has not been previously evaluated. The purpose of this study is to retrospectively compare the time span of opioid utilization between ankle fracture patients with and without diabetes mellitus. Methods: We conducted a retrospective cohort study using our institution’s TriNetX database. A total of 640 ankle fracture patients were included in the analysis, of whom 73 had diabetes. All dates of opioid use for each patient were extracted from the data set, including the first and last date of opioid prescription. Descriptive analysis and logistic regression models were employed to explore the differences in opioid use between patients with and without diabetes after ankle fracture repair. A 2-tailed P value of .05 was set as the threshold for statistical significance. Results: Logistic regression models revealed that patients with diabetes are less likely to stop using opioids within 90 days, or within 180 days, after repair compared to patients without diabetes. Female sex, neuropathy, and prefracture opioid use are also associated with prolonged opioid use after ankle fracture repair. Conclusion: In our study cohort, ankle fracture patients with diabetes were more likely to require prolonged opioid use after fracture repair. Level of Evidence: Level III, prognostic.

scholarly journals Postoperative Pain and Opioid Use Following Surgical Treatment of Ankle Fractures

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0033
Author(s):  
Matthew Pate ◽  
Jacob Hall ◽  
John Anderson ◽  
Donald Bohay ◽  
John Maskill ◽  
...  
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Ankle Fracture ◽  
Management Practices ◽  
Opioid Analgesic ◽  
The United States ◽  
Ankle Fractures ◽  
Opioid Use ◽  
Opioid Prescription ◽  
Opioid Medication

Category: Ankle, Bunion, Trauma Introduction/Purpose: Chronic opioid abuse is one of the greatest public health challenges in the United States. The most common first exposure to opioids comes from acute care prescriptions, such as those after surgery. Moreover, opioids are often prescribed excessively, with current estimates suggesting ˜75% of the pills prescribed are unused. Ankle fractures are the most common operatively treated fracture in orthopaedic surgery, and management of acute pain following surgery is challenging. The optimal perioperative pain regimen is still a point of controversy, as there is limited data available regarding appropriate amount of opioid to prescribe. This study evaluates opioid prescribing techniques of multiple foot and ankle surgeons, and associated patient outcomes. We aim to help surgeons improve their pain management practices and to limit opioid overprescription. Methods: Chart review and phone survey were performed on forty two adult patients within three to six months of ankle fracture fixation at our institution. These patients were offered to voluntarily participate in a standardized questionnaire regarding pain scores, opioid use, non-opioid analgesic use, pain management satisfaction, and patient prescription education. Results: 57% of patients reported that they were given “more” or ”much more” opioid medication than needed, 38% stated that they were given the “right amount”, and 5% reported that they were given ”less” or “much less” than needed. 40.0% were on opioids prior to operation. 53.5% did not require refill of discharge opioid prescriptions, 30.2% of patients did not fill any posteroperative opioid prescription. 16.3% of patients filled their discharge prescription and at least one additionall refill (mean refill = 2.22). Mean number of reported opioid pills taken after surgery was 17.4. Mean satisfaction with overall pain management at phone follow up was 8.6/10. Conclusion: While postoperative pain and management vary substantially, a majority of patients feel that they are given more opioid medication than necessary following ankle fracture repair, and a majority of opioid prescriptions are not completely used. Going forward, it is likely that a majority of patients could experience the same beneficial results with less prescription opioid pain medication, which would reduce overpresciption and potential misuse.

scholarly journals New and Persistent Controlled Substance Use Among Patients Undergoing Mastectomy and Reconstructive Surgery

2021 ◽  
Author(s):  
Jacob C. Cogan ◽  
Rohit R Raghunathan ◽  
Melissa P Beauchemin ◽  
Melissa K Accordino ◽  
Elena B Elkin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cancer Diagnosis ◽  
Reconstructive Surgery ◽  
Breast Cancer Diagnosis ◽  
Regression Analyses ◽  
Opioid Use ◽  
Opioid Prescription ◽  
Increased Risk ◽  
One Year ◽  
Health Care Claims

Abstract PurposeProlonged use of controlled substances can place patients at increased risk of dependence and complications. Women who have mastectomy and reconstructive surgery (M+R) may be vulnerable to becoming new persistent users (NPUs) of opioid and sedative-hypnotic medications.MethodsUsing the MarketScan health care claims database, we identified opioid- and sedative-hypnotic-naïve women who had M+R from 2008-2017. Women who filled ≥1 peri-operative prescription and ≥2 post-operative prescriptions within one year after surgery were classified as NPUs. Univariate and multivariable logistic regression analyses were used to estimate rates of new persistent use and predictive factors. Risk summary scores were created based on the sum of associated factors.ResultsWe evaluated 25,270 opioid-naïve women and 27,651 sedative-hypnotic-naïve women.We found that 18,931 opioid-naïve women filled a peri-operative opioid prescription, and of those, 3,315 (17.5%) became opioid NPUs post-operatively. Additionally, 10,781 sedative-hypnotic-naïve women filled a peri-operative sedative-hypnotic prescription, and of those, 1,837 (17.0%) became sedative-hypnotic NPUs. Development of new persistent sedative-hypnotic use was associated with age ≤49 (OR 1.79 [95% CI 1.43–2.25]) and age 50-64 (1.65 [1.31-2.07]) compared to age ≥65; Medicaid insurance (1.92 [1.23–2.98]); southern residence (1.38 [1.20–1.59]); breast cancer diagnosis (1.78 [1.09–2.91]); and chemotherapy (2.24 [2.02–2.49]). Risk of NPU increased with higher risk score. Women with ≥3 of these risk factors were three times more likely to become sedative-hypnotic NPUs than patients with 0 or 1 factors (3.03 [2.60–3.53]). Comparable findings were seen regarding new persistent opioid use.ConclusionWomen who have M+R are at risk of developing both new persistent opioid and new persistent sedative-hypnotic use. A patient’s risk of becoming an NPU increases as their number of risk factors increases. Non-pharmacologic strategies are needed to manage pain and anxiety following cancer-related surgery.

Can the implementation of the Opioid Start Talking form impact the amount of opioid use in patients after ankle fracture repair?

2021 ◽  
Vol 17 (5) ◽  
pp. 397-404
Author(s):  
Benjamin Best, DO ◽  
Alan Afsari, MD ◽  
Rajan Sharma, DO ◽  
James T. Layson, DO ◽  
Marek Denisiuk, DO
Keyword(s):  
Ankle Fracture ◽  
Final Analysis ◽  
Fracture Repair ◽  
Ankle Fractures ◽  
P Value ◽  
Prescription Database ◽  
Opioid Epidemic ◽  
Opioid Use ◽  
Opioid Prescription ◽  
Significant Difference

Objective: As part of 2018 legislation aimed at fighting the opioid epidemic, the Michigan Department of Health and Human Services (MDHHS) published the “Opioid Start Talking” (OST) Form on June 1, 2018. We examined if the implementation of the OST form led to an identifiable decrease in patient opioid use. Specifically, we examined the opioid prescription quantities in patients who sustained ankle fractures that required open reduction internal fixation (ORIF).Design: Retrospective. Hospital medical records and Michigan Automated Prescription Database (MAPS) were analyzed for similar ankle fracture patients operated on by two surgeons prior to and after the initiation of the OST form. Records allowed us to track opioid filling through MAPS for 120 days after surgery in two groups: preimplementation (PRE) and post-implementation (POST) OST groups. The gathered data were analyzed by the investigators along with a staff statistician.Setting: Single-institution orthopedic practice.Patients, participants: Seventy eight patientsMain outcome measure: Average morphine milligram equivalent (MME) per patient encounter.Results: Seventy eight patients were included in the final analysis after applying the exclusion criteria. There were 38 patients in the pre-OST form period and 40 in the post-OST form period groups. The pre-OST and post-OST groups were well matched between the two surgeons. There was no evidence of a statistically significant difference found in the median MME between patients from the pre-period group to the post-period group (median 59 vs 50, P = 0.61). In regard to the injury pattern, the bimalleolar MME median was 50 (38 = 25th percentile, 67 = 75th percentile; min-max 0-175) and the trimalleolar median MME was 63 (39 =25% percentile, 81 = 75th percentile; min-max 0-249) with a P value of 0.20.Conclusions: Overall, the administration of the OST form to patients with ankle fractures did not result in a decrease in MMEs prescribed within 120 days of surgery. Although it is a start in the battle against the opioid epidemic, further evaluation of the effectiveness of the OST form is necessary.

Risk Factors for Prolonged Opioid Use After Ankle Fracture Surgery

2021 ◽  
pp. 193864002110291
Author(s):  
Matthew S. Broggi ◽  
Philip O. Oladeji ◽  
Corey Spenser ◽  
Rishin J. Kadakia ◽  
Jason T. Bariteau
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Odds Ratio ◽  
Ankle Fracture ◽  
Significant Risk ◽  
Patient Characteristics ◽  
Low Back ◽  
Opioid Use ◽  
Increased Risk ◽  
Fracture Surgery

Background The incidence of ankle fractures is increasing, and risk factors for prolonged opioid use after ankle fracture fixation are unknown. Accordingly, the purpose of this study was to investigate risk factors that lead to prolonged opioid use after surgery. Methods The Truven MarketScan database was used to identify patients who underwent ankle fracture surgery from January 2009 to December 2018 based on CPT codes. Patient characteristics were collected, and patients separated into 3 cohorts based on postoperative opioid use (no refills, refills within 6 months postoperative, and refills within 1 year postoperatively). The χ2 test and multivariate analysis were performed to assess the association between risk factors and prolonged use. Results In total, 34 691 patients were analyzed. Comorbidities most highly associated with prolonged opioid use include 2+ preoperative opioid prescriptions (odds ratio [OR] = 11.92; P < .001), tobacco use (OR = 2.03; P < .001), low back pain (OR = 1.81; P < .001), depression (OR = 1.48; P < .001), diabetes (OR = 1.34; P < .001), and alcohol abuse (OR = 1.32; P < .001). Conclusion Opioid use after ankle fracture surgery is common and may be necessary; however, prolonged opioid use and development of dependence carries significant risk. Identifying those patients at an increased risk for prolonged opioid use can aid providers in tailoring their postoperative pain regimen. Levels of Evidence Prognostic, Level III

scholarly journals New Persistent Opioid Use Among Patients With Cancer After Curative-Intent Surgery

2017 ◽  
Vol 35 (36) ◽  
pp. 4042-4049 ◽  
Author(s):  
Jay Soong-Jin Lee ◽  
Hsou Mei Hu ◽  
Anthony L. Edelman ◽  
Chad M. Brummett ◽  
Michael J. Englesbe ◽  
...  
Keyword(s):  
Risk Factors ◽  
Adjuvant Chemotherapy ◽  
Prescription Opioid ◽  
Patient Counseling ◽  
Opioid Use ◽  
Curative Intent ◽  
Data Set ◽  
Opioid Dose ◽  
Adjusted Risk ◽  
Patients With Cancer

Purpose The current epidemic of prescription opioid misuse has increased scrutiny of postoperative opioid prescribing. Some 6% to 8% of opioid-naïve patients undergoing noncancer procedures develop new persistent opioid use; however, it is unknown if a similar risk applies to patients with cancer. We sought to define the risk of new persistent opioid use after curative-intent surgery, identify risk factors, and describe changes in daily opioid dose over time after surgery. Methods Using a national data set of insurance claims, we identified patients with cancer undergoing curative-intent surgery from 2010 to 2014. We included melanoma, breast, colorectal, lung, esophageal, and hepato-pancreato-biliary/gastric cancer. Primary outcomes were new persistent opioid use (opioid-naïve patients who continued filling opioid prescriptions 90 to 180 days after surgery) and daily opioid dose (evaluated monthly during the year after surgery). Logistic regression was used to identify risk factors for new persistent opioid use. Results A total of 68,463 eligible patients underwent curative-intent surgery and filled opioid prescriptions. Among opioid-naïve patients, the risk of new persistent opioid use was 10.4% (95% CI, 10.1% to 10.7%). One year after surgery, these patients continued filling prescriptions with daily doses similar to chronic opioid users ( P = .05), equivalent to six tablets per day of 5-mg hydrocodone. Those receiving adjuvant chemotherapy had modestly higher doses ( P = .002), but patients with no chemotherapy still had doses equivalent to five tablets per day of 5-mg hydrocodone. Across different procedures, the covariate-adjusted risk of new persistent opioid use in patients receiving adjuvant chemotherapy was 15% to 21%, compared with 7% to 11% for those with no chemotherapy. Conclusion New persistent opioid use is a common iatrogenic complication in patients with cancer undergoing curative-intent surgery. This problem requires changes to prescribing guidelines and patient counseling during the surveillance and survivorship phases of care.

scholarly journals Effect of Preoperative Opioid Use on Adverse Outcomes, Medical Spending, and Persistent Opioid Use Following Elective Total Joint Arthroplasty in the United States: A Large Retrospective Cohort Study of Administrative Claims Data

Pain Medicine ◽  
2019 ◽  
Vol 21 (3) ◽  
pp. 521-531 ◽  
Author(s):  
Meridith Blevins Peratikos ◽  
Hannah L Weeks ◽  
Andrew J B Pisansky ◽  
R Jason Yong ◽  
Elizabeth Ann Stringer
Keyword(s):  
Length Of Stay ◽  
Claims Data ◽  
The United States ◽  
Adverse Outcomes ◽  
Unplanned Readmission ◽  
Administrative Claims ◽  
Opioid Use ◽  
Opioid Prescription ◽  
Opioid Dose ◽  
Opioid Users

Abstract Objective Between 17% and 40% of patients undergoing elective arthroplasty are preoperative opioid users. This US study analyzed patients in this population to illustrate the relationship between preoperative opioid use and adverse surgical outcomes. Design Retrospective study of administrative medical and pharmaceutical claims data. Subjects Adults (aged 18+) who received elective total knee, hip, or shoulder replacement in 2014–2015. Methods A patient was a preoperative opioid user if opioid prescription fills occurred in two periods: 1–30 and 31–90 days presurgery. Zero-truncated Poisson (incidence rate ratio [IRR]), logistic (odds ratio [OR]), Cox (hazard ratio [HR]), and quantile regressions modeled the effects of preoperative opioid use and opioid dose, adjusted for demographics, comorbidities, and utilization. Results Among 34,792 patients (38% hip, 58% knee, 4% shoulder), 6,043 (17.4%) were preoperative opioid users with a median morphine equivalent daily dose of 32 mg. Preoperative opioid users had increased length of stay (IRR = 1.03, 95% CI = 1.02 to 1.05), nonhome discharge (OR = 1.10, 95% CI = 1.00 to 1.21), and 30-day unplanned readmission (OR = 1.43, 95% CI = 1.17 to 1.74); experienced 35% higher surgical site infection (HR = 1.35, 95% CI = 1.14 to 1.59) and 44% higher surgical revision (HR = 1.44, 95% CI = 1.21 to 1.71); had a median $1,084 (95% CI = $833 to $1334) increase in medical spend during the 365 days after discharge; and had a 64% lower rate of opioid cessation (HR = 0.34, 95% CI = 0.33 to 0.35) compared with patients not filling two or more prescriptions across periods. Conclusions Preoperative opioid users had longer length of stay, increased revision rates, higher spend, and persistent opioid use, which worsened with dose. Adverse outcomes after elective joint replacement may be reduced if preoperative opioid risk is managed through increased monitoring or opioid cessation.

Sign in / Sign up

Export Citation Format

Share Document