Ung C, Yonekawa Y, Waljee J, et al. Persistent opioid use after ophthalmic surgery in opioid-naïve patients and associated factors. Ophthalmology 2021; 128(9): 1266-1273.
This is a retrospective claims-based cohort analysis, using a database (Optum ClinformaticsÒ DataMart Database) to determine the rate of new persistent opioid use after ophthalmic surgery. The reason that this study is important is due to the increased push to monitor opioid use and prescription, due to the ongoing opioid epidemic. This paper looks specifically at ophthalmic opioid prescription in the postoperative period in previously opioid-naïve patients.
This study uses retrospective claims in opioid-naïve patients, looking at the individual pattern of prescription refill to determine which patients had persistent opioid use after surgery. To do this, the study authors had to define what would be considered persistent opioid use.
Perioperative opioid fill was defined as an opioid prescription fill 30 days before and up to 3 days after surgery.
Refill of an opioid was defined as an initial refill in the early postoperative period, within the 30 days after surgery and/or discharge.
Persistent opioid use was defined as filling an opioid prescription BOTH in the 90 day postoperative period AND in the 91-180 day period after surgical procedure. If a patient did not have a perioperative fill but obtained opioids in the 4-90 day period after discharge, PLUS another fill in the 91-180 day after discharge, this was also defined as persistent opioid use.
As you can see from the above definitions, the authors strived to capture patients who not only had an initial fill of opioids but continued to use opioids well beyond the postoperative period. These patients were then compared to the database to determine if perioperative opioid prescription increased the rates of persistent opioid use.
Out of a total of 327,379 opioid-naïve patients, 14,841 (4.5%) had an initial perioperative opioid fill. Out of these patients, 498 (3.4%) had new persistent opioid use compared to 0.6% (1833 out of 312,538 patients) without an initial perioperative fill. Therefore, initial perioperative fill was independently associated with increased odd of new persistent opioid use (adjusted OR 6.21; 95% CI, 5.57-6.91; P<0.001).
Furthermore, among patients who filled an initial perioperative prescription, a prescription size of greater than 150 morphine milligram equivalent was associated with an increased odd of refill (adjusted OR 1.87; 95% CI, 1.58-2.22; p<0.001).
This study highlights the need to remain vigilant with opioid prescription to help minimize rates of opioid dependence. Surgeons should take care to minimize the prescription of opioids whenever possible.