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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.
Abstract:
Opioids are routinely prescribed to manage acute postoperative pain, but changes in postoperative opioid prescribing associated with the marketing of long-acting opioids such as OxyContin have not been described in the surgical cohort.
Methods:
Using a large commercial claims data set, we studied postoperative opioid prescribing after selected common surgical procedures between 1994 and 2014. For each procedure and year, we calculated the mean postoperative morphine milligram equivalents (MME) filled on the index prescription and assessed the proportion of patients who filled a high-dose prescription (≥350 MME). We reported changes in postoperative opioid prescribing over time and identified predictors of filling a high-dose postoperative opioid prescription.
Results:
We identified 1,321,264 adult patients undergoing selected common surgical procedures between 1994 and 2014, of whom 80.3% filled a postoperative opioid prescription. One in five surgery patients filled a high-dose postoperative opioid prescription. Between 1994 and 2014, the mean MME filled increased by 145%, 84%, and 85% for lumbar laminectomy/laminotomy, total knee arthroplasty, and total hip arthroplasty, respectively. The procedures most likely to be associated with a high-dose opioid fill were all orthopaedic procedures (AOR 5.20 to 7.55, P < 0.001 for all). Patients whose postoperative opioid prescription included a long-acting formulation had the highest odds of filling a prescription that exceeded 350 MME (AOR 32.01, 95% CI, 30.23-33.90).
Discussion:
After the US introduction of long-acting opioids such as OxyContin, postoperative opioid prescribing in commercially insured patients increased in parallel with broader US opioid-prescribing trends, most notably among patients undergoing orthopaedic surgical procedures. The increase in the mean annual MME filled starting in the late 1990s was driven in part by the higher proportion of long-acting opioid formulations on the index postoperative opioid prescription filled by orthopaedic surgery patients.
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