Age and postoperative opioid prescriptions: a population‐based cohort study of opioid‐naïve adults

Bethell, Jennifer; Neuman, Mark D.; Bateman, Brian T.; Hill, Andrea; Ladha, Karim; Wijeysundera, Duminda N.; Wunsch, Hannah

doi:10.1002/pds.4964

Cited by 12 publications

(13 citation statements)

References 22 publications

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“…In Canada, age has been associated with a decreased proportion of patients that filled a postoperative opioid prescription. However, the initial prescription did not typically differ in older adults 22 . In our analysis, it was difficult to isolate the effect of the age.…”

Section: Discussionmentioning

confidence: 78%

“…However, the initial prescription did not typically differ in older adults. 22 In our analysis, it was difficult to isolate the effect of the age. However, the largest study, with 69 456 patients, and with a high quality of evidence, showed a high rate of persistent use of opioids after hip fracture surgery: more than 15% in opioid-naı ¨ve patients, and more than 60% in preoperative opioid users.…”

Section: Discussionmentioning

confidence: 98%

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Persistent postoperative opioid use in Europe

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2020

European Journal of Anaesthesiology

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Context:In the United States, the postoperative opioid prescriptions have been implicated in the so called "opioid epidemic". In Europe the extent of overprescribing or misuse of opioids are unsure. Objectives: To describe the proportion of persistent postoperative opioid use of adults (>18 Years) in European countries. Design: Systematic review of the published data. Data sources: We searched the electronic literature databases MEDLINE (Ovid), Embase (Ovid), PubMed/MEDLINE and Scopus. Eligibility criteria: Studies describing opioid use of adult patients (>18 years) at least 3 months after surgery.Results: 1307 studies were found, and 12 studies were included in the review. The rate of opioid users after 3 to 6 months was extracted from the studies and categorised into type of the surgery. Nine studies investigated the opioid use after total hip or total knee arthroplasties (THA and TKA) and reported opioid user rates between 7.9% and 41% after three months. In all included studies a proportion between 2.0% and 41.0% of patients were opioid users three months after surgery. The level of evidence varied from high to very low. Conclusion:To give statements about the persistent opioid use about specific countries or surgery types is not possible. Because of the observed ranges, we can neither confirm nor rule out a possible public health problem linked to the persistent use of opioids in Europe.

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Section: Discussionmentioning

confidence: 78%

Section: Discussionmentioning

confidence: 98%

Persistent postoperative opioid use in Europe

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2020

European Journal of Anaesthesiology

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“…2 While our study does not examine opioid misuse and abuse outcomes, prior work has shown strong associations between the number and duration of opioid prescription refills and postoperative opioid misuse among formerly opioid naive surgical patients, 3 as well as potential for diversion and misuse of unused opioids. 29 Coupled with the marked variability in opioid prescribing practices across countries, 27 this suggests that overall provider postoperative opioid prescribing practices may still be an important target for interventions aimed at deterring inappropriate prescribing and reducing opioid related harms. 30,31 The actual spread in opioid prescribing by surgeons in the highest and lowest quartiles of practice was relatively small, which may explain the overall null result in our primary analysis.…”

Section: Discussionmentioning

confidence: 99%

Surgeon Postoperative Opioid Prescribing Intensity and Risk of Persistent Opioid Use Among Opioid-naive Adult Patients

et al. 2023

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Objective: The aim of this study was to determine the relationship between surgeon opioid prescribing intensity and subsequent persistent opioid use among patients undergoing surgery. Summary Background Data: The extent to which different postoperative prescribing practices lead to persistent opioid use among surgical patients is poorly understood. Methods: Retrospective population-based cohort study assessing opioid-naive adults who underwent 1 of 4 common surgeries. For each surgical procedure, the surgeons' opioid prescribing intensity was categorized into quartiles based on the median daily dose of morphine equivalents of opioids dispensed within 7 days of the surgical visit for all the surgeons' patients. The primary outcome was persistent opioid use in the year after surgery, defined as 180 days or more of opioids supplied within the year after the index date excluding prescriptions filled within 30 days of the index date. Secondary outcomes included a refill for an opioid within 30 days and emergency department visits and hospitalizations within 1 year. Results: Among 112,744 surgical patients, patients with surgeons in the highest intensity quartile (Q4) were more likely to fill an opioid prescription within 7 days after surgery compared with those in the lowest quartile (Q1) (83.3% Q4 vs 65.4% Q1). In the primary analysis, the incidence of persistent opioid use in the year after surgery was rare in both highest and lowest quartiles (0.3% Q4 vs 0.3% Q1), adjusted odds ratio (AOR) of 1.18, 95% CI 0.83–1.66). However, multiple analyses using stricter definitions of persistent use that included the requirement of a prescription filled within 7 days of discharge after surgery showed a significant association with surgeon quartile (up to an AOR 1.36, 95% CI 1.25, 1.47). Patients in Q4 were more likely to refill a prescription within 30 days (4.8% Q4 vs 4.0% Q1, AOR 1.14, 95% CI 1.04–1.24). Conclusions: Surgeons' overall prescribing practices may contribute to persistent opioid use and represent a target for quality improvement. However, the association was highly sensitive to the definition of persistent use used.

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“…We accounted for specific patient characteristics that, based on both biologic plausibility and previous literature, may be associated with filling an analgesic prescription postoperatively, including age, sex, income quintile, preoperative opioid use, and Charlson comorbidity score. [29][30][31] Finally, we adjusted for surgery type, because the volume of each surgical procedure changed over time, and each surgical procedure may be associated with varying degrees of pain and postoperative analgesic requirements.…”

Section: Discussionmentioning

confidence: 99%

Nonopioid Analgesic Prescriptions Filled after Surgery among Older Adults in Ontario, Canada: A Population-based Cohort Study

et al. 2022

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Background The objective was to assess changes over time in prescriptions filled for non-opioid analgesics for older post-operative patients in the immediate post-discharge period. We hypothesized that the number of patients who filled a non-opioid analgesic prescription increased over the study period. Methods We performed a population-based cohort study, using linked health administrative data, of 278,366 admissions ≥66 years undergoing surgery between fiscal year 2013 and 2019 in Ontario, Canada. The primary outcome was the percentage of patients with new filled prescriptions for non-opioid analgesics within 7 days of discharge, and a secondary outcome was the analgesic class. We assessed whether patients filled prescriptions for a non-opioid only, an opioid only, both opioid and non-opioid prescriptions, or a combination opioid/non-opioid. Results Overall, 22% (n=60,181) of patients filled no opioid prescription, 2% (n=5,534) filled a non-opioid only, 21% (n=59,608) filled an opioid only, and 55% (n=153,043) filled some combination of opioid and non-opioid. The percentage of patients who filled a non-opioid prescription within 7 days post-operatively increased from 9% (n=2,119) in 2013 to 28% (n=13,090) in 2019, with the greatest increase for acetaminophen: 3% (n=701) to 20% (n=9,559). The percentage of patients who filled a combination analgesic prescription decreased from 53% (n=12,939) in 2013 to 28% (n=13,453) in 2019. However, the percentage who filled both an opioid and nonopioid prescription increased: 4% (n=938) to 21% (n=9,880) so that the overall percentage of patients who received both an opioid and a non-opioid remained constant over time 76% (n= 18,642) in 2013 to 75% (n=35,391) in 2019. Conclusions The proportion of post-operative patients who fill prescriptions for non-opioid analgesics has increased. However, rather than a move to use of non-opioids alone for analgesia, this represents a shift away from combination medications towards separate prescriptions for opioids and non-opioids.

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Age and postoperative opioid prescriptions: a population‐based cohort study of opioid‐naïve adults

Cited by 12 publications

References 22 publications

Persistent postoperative opioid use in Europe

Persistent postoperative opioid use in Europe

Surgeon Postoperative Opioid Prescribing Intensity and Risk of Persistent Opioid Use Among Opioid-naive Adult Patients

Nonopioid Analgesic Prescriptions Filled after Surgery among Older Adults in Ontario, Canada: A Population-based Cohort Study

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