A national evaluation of opioid prescribing and persistent use after ambulatory anorectal surgery

被引:11
作者
Keller, Deborah S. [1 ]
Kenney, Brooke C. [2 ]
Harbaugh, Calista M. [3 ]
Waljee, Jennifer F. [4 ]
Brummett, Chad M. [5 ]
机构
[1] Columbia Univ, Herbert Irving Comprehens Canc Ctr, Dept Surg, Div Colorectal Surg,Med Ctr, New York, NY 10032 USA
[2] Univ Michigan, Inst Healthcare Policy & Innovat, Ann Arbor, MI 48109 USA
[3] Univ Michigan, Dept Surg, Med Sch, Ann Arbor, MI 48109 USA
[4] Univ Michigan, Ctr Healthcare Outcomes & Policy, Dept Surg, Med Sch, Ann Arbor, MI 48109 USA
[5] Univ Michigan, Inst Healthcare Policy & Innovat, Dept Anesthesiol, Ann Arbor, MI 48109 USA
关键词
NAIVE PATIENTS; UNITED-STATES; RISK-FACTORS; PRESCRIPTION; PATTERNS; PAIN; OVERDOSE; COHORT;
D O I
10.1016/j.surg.2020.11.006
中图分类号
R61 [外科手术学];
学科分类号
摘要
Background: Surgery is a common gateway to opioid-related morbidity. Ambulatory anorectal cases are common, with opioids widely prescribed, but there is limited data on their role in this crisis. We sought to determine prescribing trends, new persistent opioid use rates, and factors associated with new persistent opioid use after ambulatory anorectal procedures. Methods: The Optum Clinformatics claims database was analyzed for opioid-na & iuml;ve adults undergoing outpatient hemorrhoid, fissure, or fistula procedures from January 1, 2010, to June 30, 2017. The main outcome measure was the rate of new persistent opioid use after anorectal cases. Secondary outcomes were annual rates of perioperative opioid fills and the prescription size over time (oral morphine equivalents). Results: A total of 23,426 cases were evaluated: 69.09% (n = 16,185) hemorrhoids, 24.29% (n = 5,690) fissures, and 6.45% (n = 1,512) fistulas. The annual rate of perioperative opioid fills decreased on average 1.2%/year, from 72% in 2010 to 66% in 2017 (P < .001). Prescribing rates were consistently highest for fistulas, followed by hemorrhoids, then fissures (P < .001). There was a significant reduction in prescription size (oral morphine equivalents) over the study period, with median oral morphine equivalents (interquartile range) of 280 (250-400) in 2010 and 225 (150-375) in 2017 (P < .0001). Overall, 2.1% (n = 499) developed new persistent opioid use. Logistic regression found new persistent opioid use was associated with additional perioperative opioid fills (odds ratio 3.92; 95% confidence interval: 2.92-5.27; P < .0001), increased comorbidity (odds ratio 1.15; confidence interval: 1.09-1.20; P < .00001), tobacco use (odds ratio 1.79; confidence interval: 1.37-2.36; P < .0001), and pain disorders (odds ratio, 1.49; confidence interval, 1.23-1.82); there was no significant association with procedure performed. Conclusion: Over 2% of ambulatory anorectal procedures develop new persistent opioid use. Despite small annual reductions in opioid prescriptions, there has been little change in the amount prescribed. This demonstrates a need to develop and disseminate best practices for anorectal surgery, focusing on eliminating unnecessary opioid prescribing. (c) 2020 Elsevier Inc. All rights reserved.
引用
收藏
页码:759 / 766
页数:8
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