Rates and risk factors for prolonged opioid use after major surgery: population based cohort study
Hance Clarke,Neilesh Soneji,Neilesh Soneji,Dennis T. Ko,Dennis T. Ko,Lingsong Yun,Duminda N. Wijeysundera +6 more
TLDR
Specific patient and surgical characteristics were associated with the development of prolonged postoperative use of opioids, and these findings can help better inform understanding about the long term risks of opioid treatment for acute postoperative pain.Abstract:
Objective To describe rates and risk factors for prolonged postoperative use of opioids in patients who had not previously used opioids and undergoing major elective surgery. Design Population based retrospective cohort study. Setting Acute care hospitals in Ontario, Canada, between 1 April 2003 and 31 March 2010. Participants 39 140 opioid naive patients aged 66 years or older who had major elective surgery, including cardiac, intrathoracic, intra-abdominal, and pelvic procedures. Main outcome measure Prolonged opioid use after discharge, as defined by ongoing outpatient prescriptions for opioids for more than 90 days after surgery. Results Of the 39 140 patients in the entire cohort, 49.2% (n=19 256) were discharged from hospital with an opioid prescription, and 3.1% (n=1229) continued to receive opioids for more than 90 days after surgery. Following risk adjustment with multivariable logistic regression modelling, patient related factors associated with significantly higher risks of prolonged opioid use included younger age, lower household income, specific comorbidities (diabetes, heart failure, pulmonary disease), and use of specific drugs preoperatively (benzodiazepines, selective serotonin reuptake inhibitors, angiotensin converting enzyme inhibitors). The type of surgical procedure was also highly associated with prolonged opioid use. Compared with open radical prostatectomies, both open and minimally invasive thoracic procedures were associated with significantly higher risks (odds ratio 2.58, 95% confidence interval 2.03 to 3.28 and 1.95 1.36 to 2.78, respectively). Conversely, open and minimally invasive major gynaecological procedures were associated with significantly lower risks (0.73, 0.55 to 0.98 and 0.45, 0.33 to 0.62, respectively). Conclusions Approximately 3% of previously opioid naive patients continued to use opioids for more than 90 days after major elective surgery. Specific patient and surgical characteristics were associated with the development of prolonged postoperative use of opioids. Our findings can help better inform understanding about the long term risks of opioid treatment for acute postoperative pain and define patient subgroups that warrant interventions to prevent progression to prolonged postoperative opioid use.read more
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New Persistent Opioid Use After Minor and Major Surgical Procedures in US Adults.
Chad M. Brummett,Jennifer F. Waljee,Jenna Goesling,Stephanie E. Moser,Paul Lin,Michael J. Englesbe,Amy S.B. Bohnert,Sachin Kheterpal,Brahmajee K. Nallamothu,Brahmajee K. Nallamothu +9 more
TL;DR: New persistent opioid use after surgery is common and is not significantly different between minor and major surgical procedures but rather associated with behavioral and pain disorders, which suggests its use is not due to surgical pain but addressable patient-level predictors.
Journal ArticleDOI
Incidence of and Risk Factors for Chronic Opioid Use Among Opioid-Naive Patients in the Postoperative Period
TL;DR: Retrospective analysis of administrative health claims to determine the association between chronic opioid use and surgery among privately insured patients between January 1, 2001, and December 31, 2013 found male sex, age older than 50 years, and preoperative history of drug abuse, alcohol abuse, depression, benzodiazepine use, or antidepressant use were associated with chronic opioids use among surgical patients.
Journal ArticleDOI
Postsurgical prescriptions for opioid naive patients and association with overdose and misuse: retrospective cohort study.
Gabriel A. Brat,Denis Agniel,Andrew L. Beam,Brian K. Yorkgitis,Mark C. Bicket,Mark L. Homer,Kathe Fox,Daniel B Knecht,Cheryl N. McMahill-Walraven,Nathan Palmer,Isaac S. Kohane +10 more
TL;DR: The data from this study suggest that duration of the prescription rather than dosage is more strongly associated with ultimate misuse in the early postsurgical period, and each refill and week of opioid prescription is associated with a large increase in opioid misuse among opioid naive patients.
Journal ArticleDOI
Association between concurrent use of prescription opioids and benzodiazepines and overdose: retrospective analysis
TL;DR: From 2001 to 2013, concurrent benzodiazepine/opioid use sharply increased in a large sample of privately insured patients in the US and significantly contributed to the overall population risk of opioid overdose.
Journal ArticleDOI
Persistent Opioid Use Among Pediatric Patients After Surgery.
Calista M. Harbaugh,Jay S. Lee,Hsou Mei Hu,Sean Esteban McCabe,Terri Voepel-Lewis,Michael J. Englesbe,Chad M. Brummett,Jennifer F. Waljee +7 more
TL;DR: Persistent opioid use after surgery is a concern among adolescents and young adults and may represent an important pathway to prescription opioid misuse, particularly among at-risk patients.
References
More filters
Journal ArticleDOI
Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data.
Hude Quan,Vijaya Sundararajan,Patricia Halfon,Andrew Fong,Bernard Burnand,Jean-Christophe Luthi,L. Duncan Saunders,Cynthia A. Beck,Thomas E Feasby,William A. Ghali +9 more
TL;DR: A multistep process to develop ICD-10 coding algorithms to define Charlson and Elixhauser comorbidities in administrative data and assess the performance of the resulting algorithms found these newly developed algorithms produce similar estimates ofComorbidity prevalence in administrativeData, and may outperform existing I CD-9-CM coding algorithms.
Journal ArticleDOI
An estimation of the global volume of surgery: a modelling strategy based on available data
Thomas G. Weiser,Thomas G. Weiser,Scott E. Regenbogen,Katherine D. Thompson,Alex B. Haynes,Stuart R. Lipsitz,William R. Berry,Atul A. Gawande,Atul A. Gawande +8 more
TL;DR: In view of the high death and complication rates of major surgical procedures, surgical safety should now be a substantial global public-health concern.
Journal ArticleDOI
Pharmacologic management of neuropathic pain: evidence-based recommendations.
Robert H. Dworkin,Alec B. O'Connor,Miroslav Backonja,John T. Farrar,Nanna B. Finnerup,Troels S. Jensen,Eija Kalso,John D. Loeser,Christine Miaskowski,Turo Nurmikko,Russell K. Portenoy,Andrew S.C. Rice,Brett R. Stacey,Rolf-Detlef Treede,Dennis C. Turk,Mark S. Wallace +15 more
TL;DR: Patients with neuropathic pain are challenging to manage and evidence‐based clinical recommendations for pharmacologic management are needed, and medications should be individualized, considering side effects, potential beneficial or deleterious effects on comorbidities, and whether prompt onset of pain relief is necessary.
Journal Article
An estimation of the global volume of surgery : a modelling strategy based on available data. Commentary
Stephen W. Bickler,David Spiegel,Thomas G. Weiser,Scott E. Regenbogen,Katherine D. Thompson,Alex B. Haynes,Stuart R. Lipsitz,William R. Berry,Atul A. Gawande +8 more
TL;DR: In this paper, the authors estimated the number of major operations undertaken worldwide, described their distribution, and assessed the importance of surgical care in global public health policy, based on demographic, health, and economic data for 192 member states of the World Health Organization.
Journal ArticleDOI
Diabetes in Ontario: determination of prevalence and incidence using a validated administrative data algorithm.
TL;DR: Administrative data can be used to establish population-based incidence and prevalence of diabetes, which is increasing in Ontario and is considerably higher than self-reported rates.