J. V. Vu1,2, D. C. Cron3, J. S. Lee1,2, V. Gunaseelan1,2, P. Lagisetty4, M. Wixson5, M. J. Englesbe1,2, C. Brummett2,5, J. F. Waljee1,2 1University Of Michigan,SURGERY,Ann Arbor, MI, USA 2Michigan Opioid Prescribing Engagement Network,Ann Arbor, MI, USA 3Massachusetts General Hospital,SURGERY,Boston, MA, USA 4University Of Michigan,Internal Medicine,Ann Arbor, MI, USA 5University Of Michigan,Anesthesiology,Ann Arbor, MI, USA
Introduction: Preoperative opioid exposure is common, and varies by dose, recency, duration, and continuity of fills. To date, there is little evidence to guide postoperative prescribing need based on prior opioid use. We characterized patterns of preoperative opioid exposure in patients undergoing elective surgery to identify the relationship between preoperative exposure and subsequent opioid fill after surgery.
Methods: We analyzed claims data from Clinformatics® DataMart Database for patients aged 18 – 64 years undergoing major and minor surgery between 2008 and 2015. Preoperative exposure was defined as any opioid prescription filled in the year before surgery. We used cluster analysis to group patients by the dose, recency, duration, and continuity of exposure. Our primary outcome was second postoperative fill within 30 postoperative days. Our primary explanatory variable was opioid exposure group. We used logistic regression to examine likelihood of second fill by opioid exposure group.
Results: Out of 267,252 patients, 102,748 (38%) filled an opioid prescription preoperatively. Cluster analysis yielded 6 groups of preoperative opioid exposure, ranging from minimal (27.6%) to intermittent (7.7%) to chronic exposure (2.7%). Preoperative opioid exposure was the most influential predictor of second fill, with larger effect sizes than other factors even for patients with minimal or intermittent opioid exposure. Increasing preoperative exposure was associated with risk-adjusted likelihood of requiring a second opioid fill compared to naïve patients (minimal exposure: OR 1.49, 95% CI 1.45 – 1.53; recent intermittent exposure: OR 6.51, 95% CI 6.16 – 6.88; high chronic exposure: OR 60.79, 95% CI 27.81 – 132.92, all p-values <0.001).
Conclusion: Preoperative opioid exposure is common among patients who undergo elective surgery. Although the majority of patients infrequently fill opioids prior to surgery, even minimal exposure increases the probability of needing additional postoperative prescriptions compared to opioid naïve patients. Moreover, surgeon prescribing is relatively uniform regardless of preoperative use, suggesting an opportunity to tailor opioid prescribing by patient exposure. Going forward, identifying preoperative opioid use can inform surgeon prescribing and care coordination for pain management after surgery.
