Long-Term Trends in Postoperative Opioid Prescribing, 1994 to 2014

Catherine L. Chen, Molly Moore Jeffery, Erin E. Krebs, Cornelius A. Thiels, Mark A. Schumacher, Adam J. Schwartz, Robert Thombley, Emily Finlayson, Rosa Rodriguez-Monguio, Derek Ward, R. Adams Dudley

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1 Scopus citations

Abstract

Introduction:Opioids are routinely prescribed to manage acute postoperative pain, but changes in postoperative opioid prescribing associated with the marketing of long-acting opioids such as OxyContin have not been described in the surgical cohort.Methods:Using a large commercial claims data set, we studied postoperative opioid prescribing after selected common surgical procedures between 1994 and 2014. For each procedure and year, we calculated the mean postoperative morphine milligram equivalents (MME) filled on the index prescription and assessed the proportion of patients who filled a high-dose prescription (≥350 MME). We reported changes in postoperative opioid prescribing over time and identified predictors of filling a high-dose postoperative opioid prescription.Results:We identified 1,321,264 adult patients undergoing selected common surgical procedures between 1994 and 2014, of whom 80.3% filled a postoperative opioid prescription. One in five surgery patients filled a high-dose postoperative opioid prescription. Between 1994 and 2014, the mean MME filled increased by 145%, 84%, and 85% for lumbar laminectomy/laminotomy, total knee arthroplasty, and total hip arthroplasty, respectively. The procedures most likely to be associated with a high-dose opioid fill were all orthopaedic procedures (AOR 5.20 to 7.55, P < 0.001 for all). Patients whose postoperative opioid prescription included a long-acting formulation had the highest odds of filling a prescription that exceeded 350 MME (AOR 32.01, 95% CI, 30.23-33.90).Discussion:After the US introduction of long-acting opioids such as OxyContin, postoperative opioid prescribing in commercially insured patients increased in parallel with broader US opioid-prescribing trends, most notably among patients undergoing orthopaedic surgical procedures. The increase in the mean annual MME filled starting in the late 1990s was driven in part by the higher proportion of long-acting opioid formulations on the index postoperative opioid prescription filled by orthopaedic surgery patients.

Original languageEnglish (US)
Article numbere19.00171
JournalJournal of the American Academy of Orthopaedic Surgeons Global Research and Reviews
Volume4
Issue number1
DOIs
StatePublished - 2020

Bibliographical note

Funding Information:
This research was supported by grants from UCSF Anesthesia Research Support, the Foundation for Anesthesia Education and Research (FAER), and the Mount Zion Health Fund. UCSF Anesthesia Research Support, FAER, and the Mount Zion Health Fund had no role in the design or conduct of the study; the collection, management, analysis, and interpretation of the data; the preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication.

PubMed: MeSH publication types

  • Journal Article

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