Persistent Opioid Use Among Children, Adolescents, and Young Adults After Common Cleft Operations

Bennett, Katelyn G.; Harbaugh, Calista M.; Hu, Hsou Mei; Vercler, Christian J.; Buchman, Steven R.; Brummett, Chad M.; Waljee, Jennifer F.

doi:10.1097/scs.0000000000004762

Cited by 56 publications

(76 citation statements)

References 24 publications

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“…New persistent use after surgery has been previously described, with rates between 3% and 14%. [13][14][15][16][17]22,23 , high comorbidity, and preoperative mental health and pain disorders, have each been identified in prior studies and were further validated by our findings ( Table 2). We also identified modifiable risk factors for new persistent use, including gastrointestinal complications, surgical approach (eg, thoracotomy), prescription timing, and prescription size.…”

Section: Commentsupporting

confidence: 85%

Impact of Prescribing on New Persistent Opioid Use After Cardiothoracic Surgery

Brescia

Waljee

et al. 2019

The Annals of Thoracic Surgery

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Background. New persistent opioid use occurs in 3% to 14% of patients after elective surgery, but is poorly described after cardiothoracic surgery. We examined the association of prescription size with new persistent opioid use after cardiothoracic surgery. Methods. Opioid-naive Medicare patients undergoing cardiothoracic surgery between 2009 and 2015 were identified. Patients who filled an opioid prescription between 30 days before surgery and 14 days after discharge and with continuous Medicare enrollment 12 months before and 6 months after surgery were selected (n [ 24,549). New persistent use was defined as continued prescription fills 91 to 180 days after surgery. Prescription size was reported in oral morphine equivalents. Multivariable regression was performed for risk adjustment, and new persistent use rate was estimated. Results. Patient age was 71 ± 8 years, 9222 (38%) were female, and 20,898 (85%) were white. Overall new persistent use was 12.8% (3153 of 24,549), and declined yearly from 17% in 2009 to 7.1% in 2015 (P < .001). Prescription size, preoperative prescription fills, black race, gastrointestinal complications, disability status, open lung resection, dual eligibility (Medicare and Medicaid), drug and substance abuse, female sex, tobacco use, high comorbidity, pain disorders, longer hospital stay, and younger age were associated with new persistent use. Adjusted new persistent use was 19.6% (95% confidence interval, 18.7% to 20.4%) among patients prescribed more than 450 oral morphine equivalents, compared with 10.4% (95% confidence interval, 9.9% to 10.8%) among those prescribed 200 oral morphine equivalents or less (P < .001). Conclusions. Size and timing of perioperative opioid prescriptions were the strongest predictors of new persistent opioid use after cardiothoracic surgery. Modifiable risk factors such as prescription size should be targeted to reduce new persistent use.

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Section: Commentsupporting

confidence: 85%

Impact of Prescribing on New Persistent Opioid Use After Cardiothoracic Surgery

Brescia

Waljee

et al. 2019

The Annals of Thoracic Surgery

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“…We anticipated the alternative outcome definition to be a more inclusive measure of persistent opioid use than our chosen measure of a 90-day opioid supply received in a 12-month period. 21,[35][36][37][38]…”

Section: Sensitivity Analysismentioning

confidence: 99%

New‐onset persistent opioid use following breast cancer treatment in older adult women

Roberts

Fergestrom

Neuner

et al. 2019

Cancer

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BACKGROUND: Patients with cancer-related pain are underrepresented in the opioid literature despite high opioid exposure and numerous risk factors for adverse opioid outcomes, including unnecessary persistent opioid use. The objective of this study was to determine the extent, historical trends, and predictors of new-onset persistent opioid use among older adult women after active breast cancer treatment. METHODS: Using Surveillance, Epidemiology, and End Results-Medicare data for opioid-naive women diagnosed with stage 0 to III breast cancer at the age of 66 to 90 years between 2008 and 2013, this study estimated overall and quarterly adjusted probabilities of new-onset persistent opioid use, which was defined as receiving ≥90 days' supply of opioids in the year after active breast cancer treatment. Sensitivity analyses were conducted with an alternative definition of persistent opioid use: any opioid fill 90 to 180 days after active cancer treatment. RESULTS: Nearly two-thirds of the subjects received prescription opioid therapy during cancer treatment. Quarterly probabilities of new-onset persistent opioid use after active treatment ranged from 2% to 4%; in sensitivity analyses, the alternative outcome definition resulted in predicted probabilities ranging from 11.4% to 14.7%. Subjects with more advanced disease, a higher comorbidity burden, a low-income status, and greater opioid exposure during active cancer treatment were more likely to develop persistent opioid use. CONCLUSIONS: Persistent opioid use was an infrequent occurrence among older adult patients with breast cancer completing cancer treatment between 2008 and 2013. This finding was encouraging because of the concerning opioid trends seen in noncancer populations. However, opportunities to further mitigate unsafe opioid use as a complication of cancer care, including standardization of persistent opioid use definitions, should be explored. Cancer 2020;126:814-822.

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“…(After After accounting for the duplicate studies, which appeared under various search headings, 230 distinct articles were identified. The review of the abstracts and/or full texts yielded 17 articles, which evaluated the risk of OUD from opioids administered perioperatively and were therefore retained for further analysis (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22). The excluded studies pertained to a range of topics including opioid sparing perioperative analgesic techniques, acute opioid tolerance, opioid induced hyperalgesia, perioperative use of ketamine, lidocaine and dexmedetomidine, and multimodal perioperative analgesia.…”

Section: Resultsmentioning

confidence: 99%

“…In eight studies, opioid prescriptions filled within 2 to 4 weeks prior to, and 1 to 2 weeks after the surgery, were considered as perioperative opioids; the prescriptions given preoperatively were included presumably to allow for those filled before the surgery for the perioperative use (9)(10)(11)(12)(13)(14)(15)(16). In six studies, only the pre and postoperative opioid prescriptions were noted, and the exact nature of perioperative opioids was not clear (17)(18)(19)(20)(21)(22). The results, concerned primarily with the opioid prescriptions given for a variable period spanning the time of surgery, typically at the time of hospital discharge, therefore, highlighted mainly the outpatient phase of the perioperative opioid administration.…”

Section: Resultsmentioning

confidence: 99%

“…In one study, only the absence of diagnostic codes for "opioid dependence" or "opioid over dose" were considered (19). In four other studies the varied criteria used were: "no opioids used the day of surgery" (17), "no opioids used on daily basis" (20), "no outpatient prescriptions of non-injectable opioids" (21), and "no opioids prior to the admission" (22). The presence of new OUD after surgery, in most studies, rested on the "persistent opioid use", which was based on variably recorded number of opioid prescriptions filled after the surgery (Table 1).…”

Section: Resultsmentioning

confidence: 99%

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Risk of Opioid Use Disorder from Exposure to Opioids in the Perioperative Period: A Systematic Review

et al. 2020

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Opioid use disorder, a major source of morbidity and mortality globally, is regularly linked to opioids given around the time of surgery. Perioperative period, however, is markedly heterogeneous, with the diverse providers using opioids distinctively, and the various drivers of opioid misuse at-play dissimilarly, throughout the perioperative period. The risk of opioid use disorder may, therefore, be different from opioids given at the various phases of perioperative care, and the ensuing recommendations for their use may also be dissimilar. Systematic search and analysis of the pertinent literature, following the accepted standards, showed an overall increased risk of misuse from the perioperative opioids. However, the analyzed studies had significant methodological limitations, and were constrained mainly to the outpatient phase of the perioperative period. Lacking any data, this risk, therefore, is unknown for intraoperative and postoperative recovery periods. Consequently, no firm recommendations can be extended to anesthesia providers generally managing these perioperative stages. Furthermore, with significant methodological limitations, the current recommendations for opioid use after surgery are also arbitrary. Thus, though proposals for perioperative opioid use are formulated in this article, substantive recommendations would require clear delineation of these risks, while avoiding the limitations noted in this review.

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Persistent Opioid Use Among Children, Adolescents, and Young Adults After Common Cleft Operations

Abstract: New persistent opioid use occurs after cleft-related procedures and could lead to chronic use in children, adolescents, and young adults.

Cited by 56 publications

References 24 publications

Impact of Prescribing on New Persistent Opioid Use After Cardiothoracic Surgery

Impact of Prescribing on New Persistent Opioid Use After Cardiothoracic Surgery

New‐onset persistent opioid use following breast cancer treatment in older adult women

Risk of Opioid Use Disorder from Exposure to Opioids in the Perioperative Period: A Systematic Review

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