Elsevier

The Journal of Hand Surgery

Volume 41, Issue 10, October 2016, Pages 947-957.e3
The Journal of Hand Surgery

Editor's choice
Risk of Prolonged Opioid Use Among Opioid-Naïve Patients Following Common Hand Surgery Procedures

https://doi.org/10.1016/j.jhsa.2016.07.113Get rights and content

Purpose

To evaluate prolonged opioid use in opioid-naïve patients after common hand surgery procedures in the United States.

Methods

We studied insurance claims from the Truven MarketScan databases to identify opioid-naïve adult patients (no opioid exposure 11 months before the perioperative period) who underwent an elective (carpal tunnel release, carpometacarpal arthroplasty/arthrodesis, cubital tunnel release, or trigger finger release) or trauma-related (closed distal radius fracture fixation, flexor tendon repair, metacarpal fracture fixation, or phalangeal fracture fixation) hand surgery procedure between 2010 and 2012 (N = 77,573 patients). Patients were observed for 6 months to determine the number, timing, duration, and oral morphine equivalent dosage of postoperative opioid prescriptions. We assessed prolonged postoperative opioid use, defined as patients who filled a perioperative opioid prescription followed by a prescription between 90 and 180 days after surgery, and evaluated associated risk factors using multivariable logistic regression.

Results

In this cohort, 59,725 opioid-naïve patients (77%) filled a perioperative opioid prescription. Of these, 13% of patients continued to fill prescriptions between 90 and 180 days after surgery. Elective surgery patients were more likely to continue to fill opioid prescriptions after 90 days compared with trauma patients (13.5% vs 10.5%). Younger age, female gender, lower income, comprehensive insurance, higher Elixhauser comorbidity index, mental health disorders, and tobacco dependence or abuse were associated with prolonged opioid use.

Conclusions

Approximately 13% of opioid-naïve patients continue to fill opioid prescriptions after hand surgery procedures 90 days after surgery. Preoperative interventions centered on opioid alternatives and early cessation, particularly among patients at risk for long-term use, is critical to addressing the prescription opioid crisis in the United States.

Clinical relevance

The current national opioid use epidemic requires an assessment of the prevalence of hand surgery patients who receive and fill opioid prescriptions after 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)

  • L. Manchikanti et al.

    Therapeutic opioids: a ten-year perspective on the complexities and complications of the escalating use, abuse, and nonmedical use of opioids

    Pain Physician

    (2008)
  • National Institute on Drug Abuse. Trends & statistics. Available at:...
  • Centers for Disease Control and Prevention. Opioid data analysis. Available at:...
  • Y. Olsen

    The CDC guideline on opioid prescribing—rising to the challenge

    JAMA

    (2016)
  • A.S. Bohnert et al.

    Trends and regional variation in opioid overdose mortality among Veterans Health Administration patients, fiscal year 2001 to 2009

    Clin J Pain

    (2014)
  • L. Manchikanti et al.

    Opioid epidemic in the United States

    Pain Physician

    (2012)
  • Executive Office of the President of the United States. Epidemic: responding to America’s prescription drug abuse...
  • A. Kolodny et al.

    The prescription opioid and heroin crisis: a public health approach to an epidemic of addiction

    Annu Rev Public Health

    (2015)
  • R.N. Hansen et al.

    Economic costs of nonmedical use of prescription opioids

    Clin J Pain

    (2011)
  • M. Menendez et al.

    Attitudes and self-reported practices of hand surgeons regarding prescription opioid use

    Hand

    (2015)
  • Centers for Disease Control and Prevention. Guideline for prescribing opioids for chronic pain. Available at:...
  • A. Alam et al.

    Long-term analgesic use after low-risk surgery: a retrospective cohort study

    Arch Intern Med

    (2012)
  • H. Clarke et al.

    Rates and risk factors for prolonged opioid use after major surgery: population based cohort study

    BMJ

    (2014)
  • J.L.C. Wilson et al.

    Opioid use among same-day surgery patients: prevalence, management and outcomes

    Pain Res Manag

    (2015)
  • J.F. Waljee et al.

    The use of opioid analgesics following common upper extremity surgical procedures: a national, population-based study

    Plast Reconstr Surg

    (2016)
  • H. Wunsch et al.

    Opioids prescribing after low-risk surgical procedures in the United States, 2004-2012

    JAMA

    (2016)
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