Abstract
Background
It is unknown if opioid naïve patients who undergo minimally invasive, benign foregut operations are at risk for progressing to persistent postoperative opioid use. The purpose of our study was to determine if opioid naïve patients who undergo minimally invasive, benign foregut operations progress to persistent postoperative opioid use and to identify any patient- and surgery-specific factors associated with persistent postoperative opioid use.
Methods
Opioid-naïve, adult patients who underwent laparoscopic fundoplication, hiatal hernia repair, or Heller myotomy from 2010 to 2018 were identified within the IBM® MarketScan® Commercial Claims and Encounters Database. Daily drug logs of the preoperative and postoperative period were evaluated to assess for changes in drug use patters. The primary outcome of interest was persistent postoperative opioid use, defined as at least 33% of the proportion of days covered by opioid prescriptions at 365-day follow-up. Patient demographic information and clinical risk factors for persistent postoperative opioid use at 365 days postoperatively were estimated using log-binomial regression.
Results
A total of 17,530 patients met inclusion criteria; 6895 underwent fundoplication, 9235 underwent hiatal hernia repair, and 1400 underwent Heller myotomy. 9652 patients had at least one opioid prescription filled in the perioperative period. Sixty-five patients (0.4%) were found to have persistent postoperative opioid use at 365 days postoperatively. Lower Charlson comorbidity index scores and a history of mental illness or substance use disorder had a statistically but not clinically significant protective effect on the risk of persistent postoperative opioid use at 365 days postoperatively.
Conclusions
Only half of opioid naïve patients undergoing minimally invasive, benign foregut operations filled an opioid prescription postoperatively. The risk of progression to persistent postoperative opioid use was less than 1%. These findings support the current guidelines that limit the number of opioid pills prescribed following general surgery operations.
Similar content being viewed by others
References
Walid MS, Donahue SN, Darmohray DM, Hyer LA, Robinson JS (2008) The fifth vital sign- what does it mean? Pain Pract 8(6):417–422
Mularski RA, White-Shu F, Overbay D, Miller L, Asch SM, Ganzini L (2006) Measuring pain as the 5th vital sign does not improve quality of pain management. J Gen Intern Med 21(6):607–612
Kim MP, Godoy C, Nguyen DT, Meisenbach LM, Chihara R, Chan EY, Graviss EA (2020) Preemptive pain-management program is associated with reduction of opioid prescriptions after benign minimally invasive foregut surgery. J Thorac Cardiovasc Surg 159(2):734–744
Scher C, Meader L, Van Cleave JH, Reid MC (2017) Moving beyond pain as the fifth vital sign and patient satisfaction scores to improve pain care in the 21st century. Pain Manag Nurs 19(2):125–129
Hill M, McMahon M, Stucke R, Barth R (2017) Wide variation and excessive dosage of opioid prescriptions for common general surgery procedures. Ann Surg 265(4):709–714
Prescription Opioid Data Prescribing Practices (2021) https://www.cdc.gov/drugoverdose/deaths/prescription/practices.html. Accessed 26 July 2021.
Clarke H, Soneji N, Ko DT, Yun L, Wijeysundera DN (2014) Rates and risk factors for prolonged opioid use after major surgery: population based cohort study. BMJ 348:g1251
Overton HN, Hanna MN, Bruhn WE, Hutfless S, Bicket MC, Makary MA, Opioids after Surgery Workgroup (2018) Opioid-prescribing guidelines for common surgical procedures: an expert panel consensus. J Am Coll Surg 227(4):411–418
Thiels CA, Ubl DS, Yost KJ, Dowdy SC, Mabry TM, Gazelka HM, Cima RR, Habermann EB (2018) Results of a prospective, multicenter initiative aimed at developing opioid-prescribing guidelines after surgery. Ann Surg 268(3):457–468
Yan D and Dalton JE (2012) A unified approach to measuring the effect size between two groups using SAS®. https://support.sas.com/resources/papers/proceedings12/335-2012.pdf. Accessed 20 Nov 2020.
Analyzing Opioid Prescription Data and Oral Morphine Milligram Equivalents (MME) (2021) https://www.cdc.gov/opioids/data-resources/index.html. Accessed 6 Aug 2021.
Deyo RA, Cherkin DC, Ciol MA (1992) Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 45(6):613–619
Lee JSJ, Edelman AL, Brummett CM, Englesbe MJ et al (2017) New persistent opioid use among patients with cancer after curative-intent surgery. J Clin Oncol 35(56):4042–4049
Cochran G, Gordon AJ, Lo-Ciganic WH, Gellad WF et al (2017) An examination of claims-based predictors of overdose from a large medicaid program. Med Care 55(3):291–298
Injuries and Violence are Leading Causes of Death (2021) https://www.cdc.gov/injury/wisqars/animated-leading-causes.html#:~:text=from%201981%2D2019-,Unintentional%20injuries%20are%20the%20leading%20cause%20of%20death%20for%20Americans,unintentional%20drowning%2C%20and%20unintentional%20falls. Accessed 20 Aug 2021.
Kim B, Nolan S, Beaulieu T, Shalansky S, Ti L (2019) Inappropriate opioid prescribing practices: a narrative review. Am J Health Syst Pharm 76(16):1231–1237
Lev R, Lee O, Petro S, Lucas J et al (2016) Who is prescribing controlled medications to patients who die of prescription drug abuse? Am J Emerg Med 34(1):30–35
Lazar DJ, Zaveri S, Khetan P, Nobel T, Divino CM (2021) Variations in postoperative opioid prescribing by day of week and duration of hospital stay. Surgery 169(4):929–933
Hill MV, McMahon ML, Stucke RS, Barth RJ (2017) Wide variation and excessive dosage of opioid prescriptions for common general surgical procedures. Ann Surg 265(4):709–714
McDonald DC, Carlson K, Izrael D (2012) Geographic variation in opioid prescribing in the U. S. J Pain 1310:988–996
Sun EC, Darnall BD, Baker LC, Mackey S (2016) Incidence of and risk factors for chronic opioid use among opioid-naïve patients in the postoperative period. JAMA Intern Med 176(9):1286–1293
Adogwa O, Davidson MA, Vuong VD, Desai SA et al (2019) Regional variation in opioid use after lumbar spine surgery. World Neurosurg 121:e691–e699
Hah J, Bateman BT, Ratliff J, Curtin C, Sun E (2017) Chronic opioid use after surgery: implications for perioperative management in the face of the opioid epidemic. Anesth Analg 125(5):1733–1740
Ardeljan LD, Waldfogel JM, Bicket MC, Hunsberger JB et al (2020) Current state of opioid stewardship. Am J Health Syst Pharm 77(8):636–643
Jivraj NK, Raghavji F, Bethell J, Wijeysundera DM et al (2020) Persistent postoperative opioid use: a systematic literature search of definitions and population-based cohort study. Anesthesiology 132(6):1528–1539
Kirson NY, Shei A, Rice JB, Enloe CJ et al (2015) The burden of undiagnosed opioid abuse among commercially insured individuals. Pain Med 16(7):1325–1332
Acknowledgements
The authors would like to acknowledge Virginia Pate, MS for her contributions in data preparation, definition development, and programming for this study.
Funding
Ivy N. Haskins, MD receives royalty from UpToDate, Inc. Emilie D. Duchesneau, MSPH is supported by the Cancer Care Quality Training Program at the University of North Carolina at Chapel Hill (Grant T32 CA 116339). Paula Strassle, PhD, MSPH is supported by the Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health. The contents and views in this manuscript are those of the authors and should not be construed to represent the views of their employers.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Disclosures
Ivy N. Haskins, Emilie D. Duchesneau, Chris B. Agala, Stephanie T. Lumpkin, Paula D. Strassle, and Timothy M. Farrell have not disclosed any funding directly related to this study.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Haskins, I.N., Duchesneau, E.D., Agala, C.B. et al. Minimally invasive, benign foregut surgery is not associated with long-term, persistent opioid use postoperatively: an analysis of the IBM® MarketScan® database. Surg Endosc 36, 8430–8440 (2022). https://doi.org/10.1007/s00464-022-09123-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-022-09123-y