Opioid Dependence and Overdose after Surgery: Rate, Risk Factors and Reasons
Jennifer Wylie1, Lixi Kong2, Richard J. Barth3
1Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, United States, 2Dartmouth-Hitchcock Medical Center Analytics Institute, Lebanon, New Hampshire, United States, 3Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, United States
Objectives: Determine incidence of "opioid never events" (ONE), defined as the development of opioid dependence or overdose in a patient who is opioid naïve, has surgery, and is prescribed opioids postoperatively. Identify risk factors that predict ONE. Design: Retrospective electronic medical record (EMR) review. Setting: Academic medical center. Patients: 39,551 opioid naïve surgical patients prescribed opioids post-operatively between 1/1/2015 and 12/31/2018 and followed through 3/31/2020. ONE determined by ICD-9 and -10 codes and EMR review. Main Outcome Measures: Rate, risk factors and reasons for ONE. Results: ONE occurred in 0.17% (67/39,551) of surgical patients. Normalized ONE rates were 0.22% in 2015, 0.25% in 2016, 0.27% in 2017 and 0.20% in 2018. Ten of the 67 ONE patients overdosed on opioids; 57 developed opioid dependence without overdose. Mean and median times to ONE were 1.9 and 1.6 years, respectively. The ONE rate was significantly higher in patients 25-34 years of age, thoracic surgery patients and patients whose primary payor was Medicaid. Patients receiving an opioid prescription 90-180 days after surgery were more likely to develop an ONE (0.98% vs 0.14%, p <0.0001). Well-defined reasons (eg. cancer-related pain) were identified for 52% of ONE; 48% of patients developed ONE for non-specific reasons. Twelve of the 67 ONE patients progressed to IV drug use; 4 attempted suicide. Conclusions: Postoperative opioid dependence or overdose is a significant health problem, affecting roughly 2 of every thousand opioid-naïve patients prescribed an opioid after surgery. Reasons for opioid dependence or overdose are non-specific in half of these patients. Risk factors for development of ONE include patient age, surgical procedure, insurer and filling an opioid prescription 90-180 days after surgery.
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