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Area of Science:

  • Pain Management
  • Surgical Outcomes
  • Pharmacovigilance

Background:

  • Preoperative opioid use is prevalent before elective surgery.
  • Patterns of use (dose, recency, duration, continuity) vary widely.
  • Limited evidence exists to guide postoperative prescribing based on preoperative opioid use.

Purpose of the Study:

  • To characterize preoperative opioid use patterns in patients undergoing elective surgery.
  • To identify the relationship between preoperative opioid use and subsequent opioid fills post-surgery.

Main Methods:

  • Analysis of claims data from 267,252 patients (aged 18-64) undergoing surgery (2008-2015).
  • Cluster analysis to group patients based on preoperative opioid use (dose, recency, duration, continuity).
  • Logistic regression to assess the likelihood of a second postoperative opioid fill within 30 days.

Main Results:

  • 38% of patients filled a prescription in the year before surgery.
  • Six distinct preoperative opioid use groups were identified, from minimal to chronic.
  • Preoperative opioid use was a strong predictor of needing a second postoperative fill, even for minimal use.

Conclusions:

  • Even minimal preoperative opioid use increases the probability of requiring additional postoperative prescriptions.
  • Identifying preoperative opioid use is crucial for informing surgeon prescribing and pain management strategies.
  • This study highlights the importance of assessing prior opioid use for optimizing postsurgical pain care.