A. O. Luby1, D. Allesio-Bilowus2, H. Hu2, C. M. Brummett2,3, J. F. Waljee1,2, M. C. Bicket2,3 1University Of Michigan, Department Of Surgery, Ann Arbor, MI, USA 2University Of Michigan, Opioid Prescribing Engagement Network, Institute For Healthcare Policy And Innovation, Ann Arbor, MI, USA 3University Of Michigan, Department Of Anesthesiology, Ann Arbor, MI, USA
Introduction: New persistent opioid use after surgery among opioid naïve individuals has emerged as an important postoperative complication. In response, numerous efforts to promote safe post-operative opioid prescribing practices have been adopted in recent years, including prescribing guidelines and policies to limit prescription sizes for acute pain. However, current estimates of the incidence of new persistent opioid use following surgery remain unknown. We sought to define recent trends in opioid prescribing after surgery and new persistent opioid use in the United States.
Methods: Using Health Care Cost Institute data, we identified privately insured adult patients undergoing common surgical procedures between 2013 and 2021 without opioid fills in the year prior to surgery. The primary outcome was the initial opioid prescription size in oral morphine equivalents (OME). The secondary outcome of interest was new persistent opioid use, which was defined as an opioid prescription filled within 4-90 days and another prescription filled between 90 and 180 days after the procedure. We evaluated trends in opioid prescribing patterns over time and rates of new persistent opioid use across the study period. A mixed effect logistic regression was performed to evaluate independent predictors of new persistent opioid use while adjusting for patient-level factors and year.
Results: In total, 986,090 patients met the inclusion criteria, with 670,143 (68.0%) undergoing minor surgical procedures and 315,947 (32.0%) undergoing major surgical procedures. The adjusted incidence of new persistent opioid use decreased from 2.7% in 2013 (95% CI: 2.6%-2.8%) to 1.0% in 2021 (95% CI: 1.0%-1.1%) over the study period. Concurrently, the adjusted initial opioid prescription size decreased from 371 mg OME (95% CI: 367-375) to 231 mg OME (95% CI: 227-235). Notably, across all study years, the odds of new persistent opioid use was significantly higher for every 10 tablets of 5 mg oxycodone (75 OME) increase (OR=2.18, 95% CI: 2.10-2.26, p<0.001).
Conclusion: Encouragingly, both opioid prescription size after surgery and new persistent opioid use and have decreased since 2013. These trends over time suggest that increased awareness of opioid related harms can promote safer opioid stewardship, which has favorable effects on the risk of long-term opioid use. Evidence-based guidelines and policies which limit prescribing for acute pain are important components of current strategies focused on reducing opioid-related harms after surgery.
