Higher risk of persistent opioid use in patients with an initial perioperative prescription

This large study looked at the risk and rate of persistent opioid use in patients after ophthalmic surgery.

Study design

This retrospective claims-based cohort analysis looked at national data over 5 years for 327,379 postoperative opioid-naive patients 13 years of age and older to determine the rate and risk of persistent new opioid use.

Outcomes

Exposure to opioids in the perioperative period was associated with new persistent use in patients who were previously opioid-naive. Of the 4.5% of patients in this large cohort who had an initial perioperative opioid fill, the rate of new persistent opioid use was 3.4% compared with 0.6% in patients who did not have an initial perioperative opioid prescription.

Limitations

This study was limited to participants with private insurance who made claims. There were geographic differences with higher opioid use in the South and West, but these were not population-based data and did not include patients with non-private insurance. Regional differences could be a result of higher physician subscription rates, state laws, and other local factors. Another limitation of this study is that opioid refills do not necessarily equate with opioid consumption.

Clinical significance

Current opioid prescribing practices are typically at the discretion of the surgeon. Therefore, interventions to limit patient exposure to unnecessary postoperative opioids is prudent. To help ophthalmologists, guidelines began to be included in a continuing medical education activity through the American Board of Ophthalmology in 2020. Given the national opioid crisis, surgeons should minimize prescribing opioids when possible.