Transitions of Care for Postoperative Opioid Prescribing in Previously Opioid-Naïve Patients in the USA: a Retrospective Review
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New persistent opioid use is a common postoperative complication, with 6% of previously opioid-naïve patients continuing to fill opioid prescriptions 3–6 months after surgery. Despite these risks, it is unknown which specialties prescribe opioids to these vulnerable patients.
To identify specialties prescribing opioids to surgical patients who develop new persistent opioid use.
Design, Setting, and Participants
Using a national dataset of insurance claims, we identified opioid-naïve patients aged 18–64 years undergoing surgical procedures (2008–2014) who continued filling opioid prescriptions 3 to 6 months after surgery. We then examined opioid prescriptions claims during the 12 months after surgery, and identified prescribing physician specialty using National Provider Identifier codes.
Percentage of opioid prescriptions provided by each specialty evaluated at 90-day intervals during the 12 months after surgery.
We identified 5276 opioid-naïve patients who developed new persistent opioid use. During the first 3 months after surgery, surgeons accounted for 69% of opioid prescriptions, primary care physicians accounted for 13%, Emergency Medicine accounted for 2%, Physical Medicine & Rehabilitation (PM&R)/Pain Medicine accounted for 1%, and all other specialties accounted for 15%. In contrast, 9 to 12 months after surgery, surgeons accounted for only 11% of opioid prescriptions, primary care physicians accounted for 53%, Emergency Medicine accounted for 5%, PM&R/Pain Medicine accounted for 6%, and all other specialties provided 25%.
Among surgical patients who developed new persistent opioid use, surgeons provide the majority of opioid prescriptions during the first 3 months after surgery. By 9 to 12 months after surgery, however, the majority of opioid prescriptions were provided by primary care physicians. Enhanced care coordination between surgeons and primary care physicians could allow earlier identification of patients at risk for new persistent opioid use to prevent misuse and dependence.
KEY WORDScare transitions postoperative care patient-centered outcomes research surgery health services research surgery
This work has not been previously published or presented.
Dr. Lee is a National Research Service Award postdoctoral fellow supported by the National Cancer Institute (5T32 CA009672-23). Drs. Brummett, Englesbe, and Waljee receive funding from the Michigan Department of Health and Human Services. Mr. Klueh is supported by the National Institutes of Health’s T35 Short-Term Training Grant for Medical Students (5T35 HL007690-34). The content of this study is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the Michigan Department of Health and Human Services.
Significant contributions to the work were completed by the authors. All authors had full access to the study data, take responsibility for the accuracy of the analysis, and approve the submission of this manuscript.
Dr. Brummett is a consultant for Recro Pharma (Malvern, PA) and Heron Pharm; not related to the present work. Dr. Brummett receives research funding from Neuros Medical Inc. (Willoughby Hills, Ohio). Dr. Englesbe receives research funding from the Substance Abuse and Mental Health Services Administration. Dr. Waljee receives research funding from the Agency for Healthcare Research and Quality (K08 1K08HS023313-01), the American College of Surgeons, and the American Foundation for Surgery of the Hand. Dr. Waljee is an unpaid consultant for 3M Health Information systems.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 1.Thiels CA, Anderson SS, Ubl DS, et al. Wide variation and overprescription of opioids after elective surgery. Ann Surg. 2017.Google Scholar
- 4.Shah A, Hayes CJ, Martin BC. Factors influencing long-term opioid use among opioid naive patients: an examination of initial prescription characteristics and pain etiologies. J Pain. 2017.Google Scholar
- 11.Baker-White A. A look at state legislation limiting opioid prescriptions. 2017; http://www.astho.org/StatePublicHealth/A-Look-at-State-Legislation-Limiting-Opioid-Prescriptions/2-23-17/. Accessed March 22, 2018.
- 26.Hill MV, Stucke RS, McMahon ML, Beeman JL, Barth RJ, Jr. An educational intervention decreases opioid prescribing after general surgical operations. Ann Surg. 2017.Google Scholar