TY - JOUR
T1 - Frequency and Risk Factors for Prolonged Opioid Prescriptions After Surgery for Brachial Plexus Injury
AU - Dy, Christopher J.
AU - Peacock, Kate
AU - Olsen, Margaret A.
AU - Ray, Wilson Z.
AU - Brogan, David M.
N1 - Funding Information:
This publication was made possible by Washington University Institute of Clinical and Translational Sciences grant UL1 TR000448 , Subaward KL2 TR000450 (for C.J.D.) from the National Institutes of Health (NIH)- National Center for Advancing Translational Sciences (NCATS), components of the NIH, and NIH Roadmap for Medical Research. The Center for Administrative Data Research (M.A.O) is supported in part by the Washington University Institute of Clinical and Translational Sciences grant UL1 TR000448 from the NCATS of the NIH, Grant Number R24 HS19455 through the Agency for Healthcare Research and Quality (AHRQ), and Grant Number KM1CA156708 through the National Cancer Institute (NCI) at the NIH. This publication’s contents are solely the responsibility of the authors and do not necessarily represent the official view of NCATS, ARHQ, NCI, or NIH.
Funding Information:
This publication was made possible by Washington University Institute of Clinical and Translational Sciences grant UL1 TR002345, Subaward KL2 TR000450 (for C.J.D.) from the National Institutes of Health (NIH)-National Center for Advancing Translational Sciences (NCATS), components of the NIH, and NIH Roadmap for Medical Research. The Center for Administrative Data Research (M.A.O.) is supported in part by the Washington University Institute of Clinical and Translational Sciences grant UL1 TR002345 from the NCATS of the NIH, Grant Number R24 HS19455 through the Agency for Healthcare Research and Quality (AHRQ), and Grant Number KM1CA156708 through the National Cancer Institute (NCI) at the NIH. This publication's contents are solely the responsibility of the authors and do not necessarily represent the official view of NCATS, ARHQ, NCI, or NIH.
Publisher Copyright:
© 2019 American Society for Surgery of the Hand
PY - 2019/8
Y1 - 2019/8
N2 - Purpose: We hypothesized that patients with preoperative opioid prescriptions and diagnoses of depression and anxiety would be at increased risk for prolonged opioid prescriptions after surgery for brachial plexus injury (BPI). Methods: Using an administrative database of privately insured patients, we assembled a cohort of BPI surgery patients and a control group of non-BPI patients, matching for age, sex, and year. Pharmacy claims for prescriptions filled for opioids and neuropathic pain medications were examined 12 months before surgery to 180 days after surgery. The primary outcome was prolonged opioid prescription, defined as receiving a prescription 90 to 180 days after the index (BPI surgery or randomly selected date of service for controls). Multivariable regression was used to examine risk factors for postoperative opioid use, including diagnoses of depression, anxiety, drug abuse, tobacco use, and preoperative use of opioids and neuropathic pain medications. A subgroup analysis was performed for opioid-naive BPI patients between 30 days to 1 year before surgery. Results: Among BPI surgery patients (n = 1,936), 27.7% had prolonged opioid prescriptions. Among opioid-naive BPI patients (n = 911), 10.8% had prolonged opioid prescriptions. In controls (n = 19,360), frequency of prolonged opioid prescriptions was 0.11%. Among all BPI patients, after adjustment for age and sex, predictors of prolonged postoperative opioid prescriptions in BPI patients were preoperative opioids, preoperative neuropathic pain medication use, histories of drug abuse, tobacco use, and anxiety. Conclusions: Prolonged postoperative opioids prescriptions after BPI reconstruction are higher than previous estimates among other surgical patients. In addition to establishing normative data among this population, our findings serve to increase awareness of risk factors for prolonged opioids after BPI reconstruction and encourage coordinated multidisciplinary care. Type of study/level of evidence: Prognostic II.
AB - Purpose: We hypothesized that patients with preoperative opioid prescriptions and diagnoses of depression and anxiety would be at increased risk for prolonged opioid prescriptions after surgery for brachial plexus injury (BPI). Methods: Using an administrative database of privately insured patients, we assembled a cohort of BPI surgery patients and a control group of non-BPI patients, matching for age, sex, and year. Pharmacy claims for prescriptions filled for opioids and neuropathic pain medications were examined 12 months before surgery to 180 days after surgery. The primary outcome was prolonged opioid prescription, defined as receiving a prescription 90 to 180 days after the index (BPI surgery or randomly selected date of service for controls). Multivariable regression was used to examine risk factors for postoperative opioid use, including diagnoses of depression, anxiety, drug abuse, tobacco use, and preoperative use of opioids and neuropathic pain medications. A subgroup analysis was performed for opioid-naive BPI patients between 30 days to 1 year before surgery. Results: Among BPI surgery patients (n = 1,936), 27.7% had prolonged opioid prescriptions. Among opioid-naive BPI patients (n = 911), 10.8% had prolonged opioid prescriptions. In controls (n = 19,360), frequency of prolonged opioid prescriptions was 0.11%. Among all BPI patients, after adjustment for age and sex, predictors of prolonged postoperative opioid prescriptions in BPI patients were preoperative opioids, preoperative neuropathic pain medication use, histories of drug abuse, tobacco use, and anxiety. Conclusions: Prolonged postoperative opioids prescriptions after BPI reconstruction are higher than previous estimates among other surgical patients. In addition to establishing normative data among this population, our findings serve to increase awareness of risk factors for prolonged opioids after BPI reconstruction and encourage coordinated multidisciplinary care. Type of study/level of evidence: Prognostic II.
KW - Brachial plexus
KW - chronic pain
KW - nerve injury
KW - neuropathic pain
KW - opioids
UR - http://www.scopus.com/inward/record.url?scp=85065186691&partnerID=8YFLogxK
U2 - 10.1016/j.jhsa.2019.04.001
DO - 10.1016/j.jhsa.2019.04.001
M3 - Article
C2 - 31078338
AN - SCOPUS:85065186691
SN - 0363-5023
VL - 44
SP - 662-668.e1
JO - Journal of Hand Surgery
JF - Journal of Hand Surgery
IS - 8
ER -