Opioid use prior to elective surgery is strongly associated with persistent use following surgery: an analysis of 14 354 Medicare patients

Abstract

BackgroundPersistent opioid use following total joint replacement (TJR) surgery is common; however, the association between pre‐surgical opioid use and surgery type has not been established. The objective of this study was to determine the association between pre‐surgery opioid use and persistent post‐surgery opioid use in TJR patients compared to other elective surgical patients.MethodsThis is a retrospective cohort study, of univariate and multinomial logistic regression of linked, de‐identified Medicare Benefits Schedule and Pharmaceutical Benefits Schedule data, adjusted for perioperative opioid use, age and sex. Oral morphine equivalents daily doses (OMEDD) were calculated and opioid use was categorized into three mutually exclusive categories for each observation window: low (0–5 OMEDD), moderate (5–10 OMEDD), high (10+ OMEDD). Persistent opioid use was defined as opioid use between 180 and 270 days after the date of surgery.ResultsPersistent opioid use was associated with older age, female gender and pre‐surgery opioid use. There was no increased risk for persistent opioid use for TJR patients compared to other surgical patients. The intensity of pre‐surgery opioid usage is strongly associated with persistent opioid use in all observed surgical patients.ConclusionsOur results suggest that many patients who use opioids prior to surgery will persist in their opioid use following surgery. No association was found between persistent opioid use and TJR surgery, but rather a risk reduction compared to other elective surgeries when associations with opioid use are controlled for. Primary care clinicians and surgeons should monitor the duration and dosage of perioperative opioid use.

Perioperative Opioids, the Opioid Crisis, and the Anesthesiologist

“…Not surprisingly, preoperative opioid use is associated with longer durations of postoperative opioid prescribing, more refills after surgery, and increased postoperative daily oral morphine equivalent consumption. 25,26 It is also a clear risk factor for chronic postoperative opioid use. 10,[27][28][29][30][31] Between 64 and 77% of chronic opioid users before surgery continue to fill opioids postoperatively.…”

Variation in ureteric re‐implantation for Australian children

“…The use of Medicare rebate data has recently been validated for use in assessing epidemiological trends, 39 and to identify significant unexplained variation in surgical management of breast cancer between states 40 . Similar to other studies using comparable methodology, our understanding is that rebate data is representative of privately insured patients who had operations in public or private hospitals 40–44 . Interestingly, some studies report that these data are all inclusive of both public and privately insured patients 45,46 .…”

Orthopaedic Nurse Navigators and Total Joint Arthroplasty Preoperative Optimization

“…Previous studies have found that persistent opioid use after surgery was more common in patients who used opioids preoperatively and that patients using opioids preoperatively had lower functional scores postoperatively (Catchpool et al, 2019;Pivec et al, 2014). One study showed that a majority of Medicare beneficiaries received opioids within the year leading up to TJA (Jin et al, 2019).…”