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Regional anesthesia and acute pain
Postsurgical opioid prescribing among veterans using community care for orthopedic surgery at non-VA hospitals compared to a VA hospital with a transitional pain service: a retrospective cohort study
  1. Michael Jacob Buys1,2,
  2. Zachary Anderson2,
  3. Kimberlee Bayless2,
  4. Chong Zhang3,
  5. Angela P Presson3,
  6. Julie Hales4 and
  7. Benjamin Sands Brooke5
  1. 1Department of Anesthesiology, University of Utah Health Hospitals and Clinics, Salt Lake City, Utah, USA
  2. 2Anesthesiology, George E Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah, USA
  3. 3Internal Medicine-Epidemiology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
  4. 4Department of Surgery, University of Utah Health, Salt Lake City, Utah, USA
  5. 5Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
  1. Correspondence to Dr Michael Jacob Buys, Department of Anesthesiology, University of Utah Health Hospitals and Clinics, Salt Lake City, UT, 84132, USA; michael.buys{at}hsc.utah.edu

Abstract

Background The USA provides medical services to its military veterans through Veterans Health Administration (VHA) medical centers. Passage of recent legislation has increased the number of veterans having VHA-paid orthopedic surgery at non-VHA facilities.

Methods We conducted a retrospective cohort study among veterans who underwent orthopedic joint surgery paid for by the VHA either at the Salt Lake City VHA Medical Center (VAMC) or at non-VHA hospitals between January 2018 and December 2021. 562 patients were included in the study, of which 323 used a non-VHA hospital and 239 patients the VAMC. The number of opioid tablets prescribed at discharge, the total number prescribed by postdischarge day 90, and the number of patients still filling opioid prescriptions between 90 and 120 days after surgery were compared between groups.

Results Veterans who underwent orthopedic surgery at a non-VHA hospital were prescribed more opioid tablets at discharge (median (IQR)); (40 (30–60) non-VHA vs 30 (20–47.5) VAMC, p<0.001) and in the first 90 days after surgery than patients who had surgery at the Salt Lake City VAMC (60 (40–120) vs 35 (20–60), p<0.001). Patients who had surgery at Salt Lake City VAMC were also significantly less likely to fill opioid prescriptions past 90 days after hospital discharge (OR (95% CI) 0.06 (0.01 to 0.48), p=0.007).

Conclusion These results suggest that veterans who have surgery at a veterans affairs hospital with a transitional pain service are at lower risk for larger opioid prescriptions both at discharge and within 90 days after surgery as well as persistent opioid use beyond 90 days after discharge than if they have surgery at a community hospital.

  • Acute Pain
  • Analgesics, Opioid
  • Opioid-Related Disorders

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/rapm-2023-105162

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • X @DrKimBaylessNP, @BenjaminSBrooke

    • Contributors Study concept and design; analysis and interpretation of data; drafting of the manuscript; critical revision of the manuscript for important intellectual content: all authors. Acquisition of data: MJB and ZA. MJB is responsible for the overall content as the guarantor.

    • Funding This work was supported by the Veterans Health Administration Office of Rural Health (ORH Contract #14434) and the University of Utah Population Health Research (PHR) Foundation, with funding in part from the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Numbers UL1TR002538 and KL2TR002539.

    • Disclaimer The content is solely the responsibility of the authors and does not necessarily represent the official views of the Federal Government or the National Institutes of Health.

    • Competing interests None declared.

    • 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.