Association of new opioid continuation with surgical specialty and type in the United States

Mark C Bicket; Irene B Murimi; Omar Mansour; Christopher L Wu; G Caleb Alexander

doi:10.1016/j.amjsurg.2019.04.010

Association of new opioid continuation with surgical specialty and type in the United States

Am J Surg. 2019 Nov;218(5):818-827. doi: 10.1016/j.amjsurg.2019.04.010. Epub 2019 Apr 15.

Authors

Mark C Bicket¹, Irene B Murimi², Omar Mansour², Christopher L Wu³, G Caleb Alexander⁴

Affiliations

¹ Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA; Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA. Electronic address: bicket@jhmi.edu.
² Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.
³ Department of Anesthesiology, Hospital for Special Surgery, New York, NY, 10021, USA; Department of Anesthesiology, Weill Cornell Medicine, New York, NY, 10021, USA.
⁴ Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA; Division of General Internal Medicine, Johns Hopkins Medicine, Baltimore, MD, 21287, USA.

PMID: 31023548
DOI: 10.1016/j.amjsurg.2019.04.010

Abstract

Background: The consequences of opioids-including post-surgical prescriptions-remain a critical public health issue. We sought to determine how procedure type and subspecialty group influence new opioid use after procedures.

Methods: We analyzed 2011-2015 IBM MarketScan Research Databases to identify opioid-naïve adults prescribed opioids for single surgical procedures. We defined new opioid continuation (primary outcome) a priori as receipt of prescription opioids between 90 and 180 days after the procedure.

Results: Among 912,882 individuals, new opioid continuation was higher for non-operating room compared to operating room procedures (13.1% versus 9.2%; aOR 1.61; 95% CI 1.59-1.64) and higher for subspecialties including colorectal surgery (aOR 1.35; 95% CI 1.26-1.43) and cardiovascular surgery (aOR 1.30; 95% CI 1.12-1.50) compared to urology as a referent. New opioid continuation was also associated with perioperative opioid prescription dosage, days' supply, preoperative receipt, and multiple prescriptions.

Conclusions: Opioids prescriptions associated with non-operating room surgical exposures appear to confer higher risk regarding conversion to new long-term opioid use.

Keywords: Analgesics; Cohort studies; Operative; Opioid; Pain; Postoperative/drug therapy; Surgical procedures.

MeSH terms

Adolescent
Adult
Ambulatory Surgical Procedures
Analgesics, Opioid / therapeutic use*
Female
Humans
Incidence
Logistic Models
Male
Middle Aged
Opioid-Related Disorders / epidemiology
Opioid-Related Disorders / etiology*
Opioid-Related Disorders / prevention & control
Pain, Postoperative / drug therapy*
Risk Factors
Specialties, Surgical*
United States / epidemiology
Young Adult

Substances

Analgesics, Opioid