Editor's choiceRisk of Prolonged Opioid Use Among Opioid-Naïve Patients Following Common Hand Surgery Procedures
Section snippets
Data source and study sample
We analyzed the Thomson Reuters Truven MarketScan Commercial Claims Research Database, which includes data from inpatient, outpatient, and pharmacy services from a range of employer-based health plans.23 This database includes information on health care use of more than 50 million active employees, early retirees, patients aged older than 65 years with Medicare Advantage or supplemental insurance (but not primary Medicare patients), and their dependents. We classified patients aged 18 or older,
Results
We identified 77,573 opioid-naïve adult patients who underwent an elective or trauma-related hand surgery between 2010 and 2012 (Table 1). Most of our patients were female (60%) and aged 45 years or older. Most patients (59,725; 77%) filled at least one perioperative opioid prescription (ie, between 30 days before surgery and 2 weeks after surgery). Younger patients (aged 18–44 years; 86%) filled a perioperative opioid prescription more frequently than did other age groups. Among those
Discussion
In this cohort of opioid-naïve adult patients, 13% continued to fill opioid prescriptions 90 days after surgical intervention. Among common hand surgeries, elective operations performed for problems including arthritis and nerve compression were more likely to be correlated with prolonged postoperative opioid use, compared with trauma-related operations. Prolonged use was also associated with younger age, female gender, greater number of comorbid conditions, lower income, mental health
Acknowledgments
This research was supported by a Mentored Clinical Investigator Award to Dr Waljee through the Agency for Healthcare Research and Quality (No. 1K08HS023313-01). Research reported in this publication was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health under Award No. 2 K24-AR053120-06 (to K.C.). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National
References (52)
- et al.
Trends in opioid analgesic-prescribing rates by specialty, U.S., 2007-2012
Am J Prev Med
(2015) - et al.
Incidence and risk factors for progression from short-term to episodic or long-term opioid prescribing: a population-based study
Mayo Clin Proc
(2015) - et al.
Management of postoperative pain: a clinical practice guideline from the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists' Committee on Regional Anesthesia, Executive Committee, and Administrative Council
J Pain
(2016) - et al.
Opioid consumption following outpatient upper extremity surgery
J Hand Surg Am
(2012) - et al.
Trends in long-term opioid therapy for noncancer pain among persons with a history of depression
Gen Hosp Psychiatry
(2009) - et al.
Trends in prescribed opioid therapy for non-cancer pain for individuals with prior substance use disorders
Pain
(2009) - et al.
Factors predicting development of opioid use disorders among individuals who receive an initial opioid prescription: mathematical modeling using a database of commercially-insured individuals
Drug Alcohol Depend
(2014) - et al.
Symptoms of depression are associated with opioid use regardless of pain severity and physical functioning among treatment-seeking patients with chronic pain
J Pain
(2015) - et al.
Factors associated with greater pain intensity
Hand Clin
(2016) - et al.
Opioid use, satisfaction, and pain intensity after orthopedic surgery
Psychosomatics
(2015)
Therapeutic opioids: a ten-year perspective on the complexities and complications of the escalating use, abuse, and nonmedical use of opioids
Pain Physician
The CDC guideline on opioid prescribing—rising to the challenge
JAMA
Trends and regional variation in opioid overdose mortality among Veterans Health Administration patients, fiscal year 2001 to 2009
Clin J Pain
Opioid epidemic in the United States
Pain Physician
The prescription opioid and heroin crisis: a public health approach to an epidemic of addiction
Annu Rev Public Health
Economic costs of nonmedical use of prescription opioids
Clin J Pain
Attitudes and self-reported practices of hand surgeons regarding prescription opioid use
Hand
Long-term analgesic use after low-risk surgery: a retrospective cohort study
Arch Intern Med
Rates and risk factors for prolonged opioid use after major surgery: population based cohort study
BMJ
Opioid use among same-day surgery patients: prevalence, management and outcomes
Pain Res Manag
The use of opioid analgesics following common upper extremity surgical procedures: a national, population-based study
Plast Reconstr Surg
Opioids prescribing after low-risk surgical procedures in the United States, 2004-2012
JAMA
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