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Association of opioid exposure before surgery with opioid consumption after surgery
  1. Mark C Bicket1,2,3,
  2. Vidhya Gunaseelan1,3,
  3. Pooja Lagisetty4,5,
  4. Anne C Fernandez6,
  5. Amy Bohnert1,2,5,
  6. Elizabeth Assenmacher7,
  7. Melwyn Sequeira8,
  8. Michael J Englesbe3,9,
  9. Chad M Brummett1,3 and
  10. Jennifer F Waljee3,9
  1. 1Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
  2. 2School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
  3. 3Opioid Prescribing Engagement Network, Institute for Healthcare Innovation and Policy, University of Michigan, Ann Arbor, Michigan, USA
  4. 4Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan, USA
  5. 5Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan, USA
  6. 6Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
  7. 7Department of Surgery, Henry Ford Allegiance Health, Jackson, Michigan, USA
  8. 8Department of Surgery, MidMichigan Medical Center, Midland, Texas, USA
  9. 9Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
  1. Correspondence to Dr Mark C Bicket, Department of Anesthesiology, University of Michigan, Ann Arbor, USA; mbicket{at}med.umich.edu

Abstract

Objective To determine the effect of prescription opioid use in the year before surgery on opioid consumption after surgery.

Background Recently developed postoperative opioid prescribing guidelines rely on data from opioid-naïve patients. However, opioid use in the USA is common, and the impact of prior opioid exposure on the consumption of opioids after surgery is unclear.

Methods Population-based cohort study of 26,001 adults 18 years of age and older who underwent one of nine elective general or gynecologic surgical procedures between January 1, 2017 and October 31, 2019, with prospectively collected patient-reported data from the Michigan Surgical Quality Collaborative (MSQC) linked to state prescription drug monitoring program at 70 MSQC-participating hospitals on 30-day patient-reported opioid consumption in oral morphine equivalents (OME) (primary outcome).

Results Compared with opioid-naïve participants, opioid-exposed participants (26% of sample) consumed more prescription opioids after surgery (adjusted OME difference 12, 95% CI 10 to 14). Greater opioid exposure was associated with higher postoperative consumption in a dose-dependent manner, with chronic users reporting the greatest consumption (additional OMEs 32, 95% CI 21 to 42). However, for eight of nine procedures, 90% of opioid-exposed participants consumed ≤150 OMEs. Among those receiving perioperative prescriptions, opioid-exposed participants had higher likelihood of refill (adjusted OR 4.7, 95% CI 4.4 to 5.1), number of refills (adjusted incidence rate ratio 4.0, 95% CI 3.7 to 4.3), and average refill amount (adjusted OME difference 333, 95% CI 292 to 374)).

Conclusions Preoperative opioid use is associated with small increases in patient-reported opioid consumption after surgery for most patients, though greater differences exist for patients with chronic use. For most patients with preoperative opioid exposure, existing guidelines may meet their postoperative needs. However, guidelines may need tailoring for patients with chronic use, and providers should anticipate a higher likelihood of postoperative refills for all opioid-exposed patients.

  • analgesics, opioid
  • pain, postoperative
  • outcome assessment, health care
  • acute pain

Data availability statement

No data are available.

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Footnotes

  • Twitter @MarkBicket, @drchadb

  • Contributors MCB and VG contributed to planning, designing, and conducting the study, data analysis, drafting, revising, and submitting the manuscript. MCB and VG act as guarantor. PL, ACF, AB, EA, and MS contributed to conducting the study, data interpretation, drafting, and revising the manuscript. MJE, CMB, and JFW contributed to the planning, designing, and conducting the study, data analysis, drafting, and revising the manuscript.

  • Funding MCB reports grants from the National Institutes of Health (R01DA042859, R01DA044987, R01DA049789), the Arnold Foundation, Michigan Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, and the US Centers for Disease Control and Prevention during the conduct of the study, and serving as consultant for Axial Healthcare and Alosa Health outside the submitted work. JFW receives funding from Michigan Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, and the Centers for Disease Control and Prevention. CMB receives funding from Michigan Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, and the Centers for Disease Control and Prevention. CMB is also supported by NIAMS P50 AR070600, NIDA R01DA038261, NIDA R01DA042859, and Common Fund UM1 NS118922. He also serves as a consultant for Heron Therapeutics, Vertex Pharmaceuticals, and Alosa Health, and provides expert medicolegal testimony.

  • Disclaimer The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH, MDHHS, or SAMHSA.

  • Competing interests MCB has received consulting fees from Axial Healthcare and Alosa Health. CMB has served as a consultant for Heron Therapeutics, Vertex Pharmaceuticals, and Alosa Health, and provides expert medicolegal testimony. Otherwise the authors declare no competing interests.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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