S. T. Lumpkin1, P. D. Strassle1, K. B. Stitzenberg1, J. L. Lund2, A. C. Kinlaw3 1University Of North Carolina At Chapel Hill,Department Of Surgery,Chapel Hill, NC, USA 2University Of North Carolina At Chapel Hill,Department Of Epidemiology,Chapel Hill, NC, USA 3University Of North Carolina At Chapel Hill,Division Of Pharmaceutical Outcomes And Policy,Chapel Hill, NC, USA
Introduction: Surgeons account for approximately two-thirds of opioid prescriptions issued to major surgery patients during the first month after surgery. Notably, the emergency department (ED) is often a source of ongoing opioid prescriptions in the susceptible population of newly discharged patients after surgery. We hypothesized that colorectal surgery (CRS) patients who received an opioid prescription from the ED were at increased risk of new persistent opioid use at one year after surgery compared to CRS patients who visited the ED but did not receive an opioid prescription there.
Methods: We analyzed data from a random 1% sub-sample of commercially insured individuals and their dependents from the IBM® MarketScan® Commercial Database. Our cohort included opioid-naïve colorectal surgery patients age 18-64 who underwent surgery during 2000-2017 and had an ED visit within 30 days after hospital discharge. New, persistent opioid use (defined as >120 days’ supply within 1 year after surgery) was compared between patients who filled an opioid prescription within 7 days of their ED visit to those who did not.
Results: Among 1,585 adult CRS patients identified, our final cohort included 241 (15%) patients who met our inclusion criteria and had an ED visit within 30 days after hospital discharge. 18% of patients filled an opioid prescription within 7 days after the ED visit (median days’ supply = 4 days, interquartile range 3-6). The overall risk of new persistent opioid use at one year was 11%. The occurrence of opioid fill after a CRS-related ED visit appeared to be associated with increased risk of new persistent opioid use compared to ED visits without a related opioid fill (18% vs 10%; risk ratio 1.83, 95% CI 0.86-3.92), but estimates were imprecise.
Conclusions: We observed a high incidence of opioid prescription fills associated with ED visits after CRS discharge. ED-related opioid fills may be associated with increased risk of persistent opioid use, which suggests that the fragmentation of pain-management care after CRS may impact new persistent opioid use. Further, our data are consistent with previously published data on new persistent opioid use after surgery (11% vs 5%). Our ongoing analyses examine this association in the full database with further covariate adjustment.