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Updated: Dec 26, 2025

An Experimental Paradigm for the Prediction of Post-Operative Pain PPOP
Published on: January 27, 2010
Long-Term Trends in Postoperative Opioid Prescribing, 1994 to 2014
Catherine L Chen1, Molly Moore Jeffery1, Erin E Krebs1
1Philip R. Lee Institute for Health Policy Studies at the University of California, San Francisco (Dr. Chen, Dr. Finlayson, Dr. Rodriguez-Monguio, Dr. Ward, and Dr. Dudley), San Francisco, CA; the Center for Healthcare Value, University of California, San Francisco (Dr. Chen), San Francisco, CA; the Department of Anesthesia and Perioperative Care, University of California, San Francisco (Dr. Chen and Dr. Schumacher), San Francisco, CA; OptumLabs Visiting Fellow (Dr. Chen), San Francisco, CA; the Department of Health Sciences Research, Mayo Clinic (Dr. Jeffery), Rochester, MN; the Department of Medicine, University of Minnesota Medical School (Dr. Krebs), Minneapolis, MN; the Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System (Dr. Krebs), Minneapolis, MN; the Department of Surgery, Memorial Sloan Kettering Cancer Center (Dr. Thiels), New York, NY; the Department of Orthopaedic Surgery, Mayo Clinic (Dr. Schwartz) Phoenix, AZ; the Center for Clinical Informatics and Improvement Research, University of California, San Francisco (Thombley), San Francisco, CA; the Department of Surgery, University of California, San Francisco (Dr. Finlayson), San Francisco, CA; the Department of Clinical Pharmacy, University of California, San Francisco (Dr. Rodriguez-Monguio), San Francisco, CA; the Medication Outcomes Center, University of California, San Francisco (Dr. Rodriguez-Monguio), San Francisco, CA; the Department of Orthopaedic Surgery, University of California, San Francisco (Dr. Ward), San Francisco, CA; and the Department of Medicine, University of California, San Francisco (Dr. Dudley), San Francisco, CA.
Postoperative opioid prescribing increased significantly after the introduction of long-acting opioids, particularly for orthopedic surgeries. High-dose prescriptions (≥350 MME) became more common, driven by long-acting formulations.
Area of Science:
- Pain Management
- Pharmacology
- Health Services Research
Background:
- Opioids are standard for acute postoperative pain management.
- The impact of long-acting opioid formulations on surgical patient prescribing patterns was previously undescribed.
Purpose of the Study:
- To analyze changes in postoperative opioid prescribing following the introduction of long-acting opioids.
- To identify trends and predictors of high-dose opioid prescriptions in surgical patients.
Main Methods:
- A large commercial claims dataset was used to study opioid prescribing from 1994-2014.
- Mean postoperative morphine milligram equivalents (MME) and high-dose prescription proportions (≥350 MME) were calculated.
- Predictors of high-dose opioid prescriptions were identified.
Main Results:
- Over 1.3 million adult surgical patients were analyzed; 80.3% received postoperative opioids.
- Mean MME increased substantially for lumbar laminectomy, total knee, and total hip arthroplasty.
- Orthopaedic procedures had the highest odds of high-dose opioid fills, with long-acting formulations significantly increasing this risk.
Conclusions:
- Postoperative opioid prescribing, particularly high-dose and long-acting formulations, increased significantly after the introduction of drugs like OxyContin.
- Orthopaedic surgery patients were most affected by these prescribing trends.
- The rise in MME was partly due to increased use of long-acting opioid formulations in surgical patients.
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