Association of opioid exposure before surgery with opioid consumption after surgery

Bicket, Mark C.; Gunaseelan, Vidhya; Lagisetty, Pooja; Fernandez, Anne C.; Bohnert, Amy S. B.; Assenmacher, Elizabeth; Sequeira, Melwyn; Englesbe, Michael J.; Brummett, Chad M.; Waljee, Jennifer F.

doi:10.1136/rapm-2021-103388

Cited by 13 publications

(10 citation statements)

References 21 publications

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“…In this retrospective cohort study by Bicket et al ,1 the authors studied 26,001 patients from 70 hospitals to determine if an association exists between preoperative opioid exposure and postoperative opioid consumption. Unlike most previous studies that relied on prescriptions filled to quantify postoperative opioid use, this study was able to report on the number of opioid pills actually consumed by patient self-report.…”

Section: Discussionmentioning

confidence: 99%

Association of opioid exposure before surgery with opioid consumption after surgery: an infographic

Schwenk

Gupta

Bicket

2022

Reg Anesth Pain Med

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Section: Discussionmentioning

confidence: 99%

Association of opioid exposure before surgery with opioid consumption after surgery: an infographic

Schwenk

Gupta

Bicket

2022

Reg Anesth Pain Med

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“…The MSQC data was also linked to data from Michigan’s prescription drug monitoring program, thereby capturing controlled substance prescription fulfillment within the state, including opioids and benzodiazepines. The linkage followed a state-approved process and a third-party reviewer removed patient identifiers from the final dataset 12 . Use of data from MSQC for this study was exempt from review by the institutional review board.…”

Section: Methodsmentioning

confidence: 99%

“…The linkage followed a state-approved process and a third-party reviewer removed patient identifiers from the final dataset. 12 Use of data from MSQC for this study was exempt from review by the institutional review board.…”

Section: Data Sourcementioning

confidence: 99%

High-risk Prescribing Following Surgery Among Payer Types for Patients on Chronic Opioids

et al. 2023

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Objective: Among those on chronic opioids, to determine whether patients with Medicaid coverage have higher rates of high-risk opioid prescribing following surgery compared with patients on private insurance. Background: Following surgery, patients on chronic opioids experience gaps in transitions of care back to their usual opioid prescriber, but differences by payer type are not well understood. This study aimed to analyze how new high-risk opioid prescribing following surgery compares between Medicaid and private insurance. Methods: In this retrospective cohort study through the Michigan Surgical Quality Collaborative, perioperative data from 70 hospitals across Michigan were linked to prescription drug monitoring program data. Patients with either Medicaid or private insurance were compared. The outcome of interest was new high-risk prescribing, defined as a new occurrence of: overlapping opioids or benzodiazepines, multiple prescribers, high daily doses, or long-acting opioids. Data were analyzed using multivariable regressions and a Cox regression model for return to usual prescriber. Results: Among 1435 patients, 23.6% (95% CI: 20.3%-26.8%) with Medicaid and 22.7% (95% CI: 19.8%-25.6%) with private insurance experienced new, postoperative high-risk prescribing. New multiple prescribers was the greatest contributing factor for both payer types. Medicaid insurance was not associated with higher odds of high-risk prescribing (odds ratio: 1.067, 95% CI: 0.813-1.402). Conclusions: Among patients on chronic opioids, new high-risk prescribing following surgery was high across payer types. This highlights the need for future policies to curb high-risk prescribing patterns, particularly in vulnerable populations that are at risk of greater morbidity and mortality.

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“…Patients with at least 1 opioid prescription in the PDMP data in the 365 days to 31 days before surgery were defined as opioid-exposed and those without opioid prescriptions during this period were defined as opioid-naive. In the subgroup analysis limited to opioid-exposed patients, we included a categorical variable for 1 of 3 opioid use patterns based on opioid prescription fills during the year before surgery: minimal (≤30 days of opioid therapy), intermittent (31–270 d of opioid therapy), and chronic (271 d or more of opioid therapy) 19 …”

Section: Methodsmentioning

confidence: 99%

“…In the subgroup analysis limited to opioid-exposed patients, we included a categorical variable for 1 of 3 opioid use patterns based on opioid prescription fills during the year before surgery: minimal ( ≤ 30 days of opioid therapy), intermittent (31-270 d of opioid therapy), and chronic (271 d or more of opioid therapy). 19…”

Section: Outcome and Explanatory Variablesmentioning

confidence: 99%

Association Between Payer Type and Risk of Persistent Opioid Use after Surgery

Srinivasan,

Gunaseelan,

Jankulov

et al. 2023

Annals of Surgery

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Objective: To assess whether the risk of persistent opioid use after surgery varies by payer type. Background: Persistent opioid use is associated with increased health care utilization and risk of opioid use disorder, opioid overdose, and mortality. Most research assessing the risk of persistent opioid use has focused on privately insured patients. Whether this risk varies by payer type is poorly understood. Methods: This cross-sectional analysis of the Michigan Surgical Quality Collaborative database examined adults aged 18 to 64 years undergoing surgical procedures across 70 hospitals between January 1, 2017 and October 31, 2019. The primary outcome was persistent opioid use, defined a priori as 1+ opioid prescription fulfillment at (1) an additional opioid prescription fulfillment after an initial postoperative fulfillment in the perioperative period or at least 1 fulfillment in the 4 to 90 days after discharge and (2) at least 1 opioid prescription fulfillment in the 91 to 180 days after discharge. The association between this outcome and payer type was evaluated using logistic regression, adjusting for patient and procedure characteristics. Results: Among 40,071 patients included, the mean age was 45.3 years (SD 12.3), 24,853 (62%) were female, 9430 (23.5%) were Medicaidinsured, 26,760 (66.8%) were privately insured, and 3889 (9.7%) were covered by other payer types. The rate of POU was 11.5% and 5.6% for Medicaid-insured and privately insured patients, respectively (average marginal effect for Medicaid: 2.9% (95% CI 2.3%-3.6%)). Conclusions: Persistent opioid use remains common among individuals undergoing surgery and higher among patients with Medicaid insurance. Strategies to optimize postoperative recovery should focus on adequate pain management for all patients and consider tailored pathways for those at risk.

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Association of opioid exposure before surgery with opioid consumption after surgery

Cited by 13 publications

References 21 publications

Association of opioid exposure before surgery with opioid consumption after surgery: an infographic

Association of opioid exposure before surgery with opioid consumption after surgery: an infographic

High-risk Prescribing Following Surgery Among Payer Types for Patients on Chronic Opioids

Association Between Payer Type and Risk of Persistent Opioid Use after Surgery

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