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Development and Validation of a Bedside Risk Assessment for Sustained Prescription Opioid Use After Surgery
Muhammad Ali Chaudhary1, Nizar Bhulani1, Elzerie C de Jager1
1Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
JAMA Network Open
|July 11, 2019
Summary
A new opioid risk score helps identify working-age patients at risk for sustained prescription opioid use after surgery. This tool aids in managing the opioid epidemic by predicting dependence potential.
Area of Science:
- Pain Management
- Addiction Medicine
- Health Informatics
Background:
- Prescription opioid misuse is a significant public health concern, particularly among working-age adults.
- Developing tools to predict sustained opioid use after surgery is crucial for risk stratification and intervention.
Purpose of the Study:
- To develop and validate the Stopping Opioids After Surgery (SOAS) risk score.
- To identify key clinical factors associated with sustained prescription opioid use in a working-age surgical population.
Main Methods:
- A case-control study analyzed TRICARE insurance claims for working-age adults undergoing common surgical procedures.
- Logistic regression identified variables predicting sustained opioid use (defined as uninterrupted use for 6 months post-surgery).
- A risk score (0-100) was calculated, with lower scores indicating reduced risk.
Main Results:
- The study included 86,356 patients; 7.4% experienced sustained prescription opioid use.
- Prior opioid exposure was the strongest predictor (OR, 13.00).
- Risk scores effectively stratified patients: low (<31) had 4.1% risk, intermediate (31-50) had 14.9% risk, and high (>50) had 35.8% risk.
Conclusions:
- The SOAS score is an intuitive and accessible tool for assessing postsurgical opioid use risk in working-age patients.
- This scalable tool can be integrated into electronic medical records for real-time clinical decision support.
- The SOAS score aids in proactive management of opioid dependence and misuse.
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