Surgical prescription opioid trajectories among state Medicaid enrollees

Jenna L. McCauley; Ralph C. Ward; David J. Taber; William T. Basco, Jr; Mulugeta Gebregziabher; Charles Reitman; William P. Moran; Robert A. Cina; Mark A. Lockett; Sarah J. Ball

doi:10.5055/jom.0832

Authors

Jenna L. McCauley, PhD https://orcid.org/0000-0001-8406-2329
Ralph C. Ward, PhD
David J. Taber, PharmD, MS
William T. Basco, Jr, MD, MS
Mulugeta Gebregziabher, PhD
Charles Reitman, MD
William P. Moran, MD
Robert A. Cina, MD
Mark A. Lockett, MD
Sarah J. Ball, PharmD

DOI:

https://doi.org/10.5055/jom.0832

Keywords:

opioid, surgery, narcotics, trends, risk factors

Abstract

Objective: The objective of this study was to evaluate opioid use trajectories among a sample of 10,138 Medicaid patients receiving one of six index surgeries: lumbar spine, total knee arthroplasty, cholecystectomy, appendectomy, colon resection, and tonsillectomy.

Design: Retrospective cohort.

Setting: Administrative claims data.

Patients and participants: Patients, aged 13 years and older, with 15-month continuous Medicaid eligibility surrounding index surgery, were selected from single-state Medicaid medical and pharmacy claims data for surgeries performed between 2014 and 2017.

Interventions: None.

Main outcome measures: Baseline comorbidities and presurgery opioid use were assessed in the 6 months prior to admission, and patients' opioid use was followed for 9 months post-discharge. Generalized linear model with log link and Poisson distribution was used to determine risk of chronic opioid use for all risk factors. Group-based trajectory models identified groups of patients with similar opioid use trajectories over the 15-month study period.

Results: More than one in three (37.7 percent) patients were post-surgery chronic opioid users, defined as the dichotomous outcome of filling an opioid prescription 90 or more days after surgery. Key variables associated with chronic post-surgery opioid use include presurgery opioid use, 30-day post-surgery opioid use, and comorbidities. Latent trajectory modeling grouped patients into six distinct opioid use trajectories. Associates of trajectory group membership are reported.

Conclusions: Findings support the importance of surgeons setting realistic patient expectations for post-surgical opioid use, as well as the importance of coordination of post-surgical care among patients failing to fully taper off opioids within 1-3 months of surgery.

Author Biographies

Jenna L. McCauley, PhD

Addiction Science Division, Department of Psychiatry, The Medical University of South Carolina, Charleston, South Carolina

Ralph C. Ward, PhD

Public Health Sciences, The Medical University of South Carolina, Charleston, South Carolina

David J. Taber, PharmD, MS

Surgery, The Medical University of South Carolina, Charleston, South Carolina

William T. Basco, Jr, MD, MS

Pediatrics, The Medical University of South Carolina, Charleston, South Carolina

Mulugeta Gebregziabher, PhD

Public Health Sciences, The Medical University of South Carolina, Charleston, South Carolina

Charles Reitman, MD

Department of Orthopaedics and Physical Medicine, The Medical University of South Carolina, Charleston, South Carolina

William P. Moran, MD

College of Medicine, The Medical University of South Carolina, Charleston, South Carolina

Robert A. Cina, MD

Surgery, The Medical University of South Carolina, Charleston, South Carolina

Mark A. Lockett, MD

Surgery, The Medical University of South Carolina, Charleston, South Carolina

Sarah J. Ball, PharmD

College of Medicine, The Medical University of South Carolina, Charleston, South Carolina

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