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Does Surgical Intensity Correlate With Opioid Prescribing?: Classifying Common Surgical Procedures
Hoyune E Cho1, Hsou-Mei Hu1,2, Vidhya Gunaseelan1,2
1Department of Surgery, University of Michigan, Ann Arbor, Michigan.
Annals of Surgery
|August 3, 2020
Summary
Surgical intensity correlates with opioid prescribing and refill rates. Higher surgical intensity means more opioids prescribed and higher refill rates, offering a guide for procedures lacking specific guidelines.
Area of Science:
- Surgical Oncology
- Pain Management
- Health Services Research
Background:
- Postoperative opioid prescribing guidelines are incomplete for many surgical procedures.
- A framework based on surgical intensity could guide prescribing where guidelines are absent.
Purpose of the Study:
- To investigate the relationship between surgical intensity and postoperative opioid prescribing.
- To develop a classification system for surgical procedures based on intensity to inform prescribing practices.
Main Methods:
- Clustering analysis of 4 surgical intensity factors: cardiac risk, pain score, operative time, and work relative value units.
- Analysis of 2,407,210 patients from the IBM MarketScan Research Database (2010-2017) to correlate surgical intensity clusters with opioid prescribing and refill rates.
Main Results:
- Five ordinal clusters of surgical intensity were identified: low to high.
- Increased surgical intensity correlated with higher median opioid amounts prescribed (150-300 OME) and increased refill rates (17.4%-48.9%).
- High-intensity procedures showed 4.37 times greater odds of opioid refill compared to low-intensity procedures.
Conclusions:
- Surgical intensity is a significant factor associated with initial opioid prescribing and refill rates.
- This framework can guide opioid prescribing for procedures lacking patient-reported outcome-based guidelines.
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