Perioperative opioid fill tied to new persistent use in ophthalmic surgery patients

Exposure to opioids in the perioperative period appears to result in new persistent use in patients who were previously opioid-naïve, according to a study, which suggests that exposure to opioids is an independent risk factor for persistent use in those undergoing incisional ophthalmic surgery.

This retrospective claims-based cohort analysis included 327,379 opioid-naïve patients (mean age 67 years, 54.4 percent women) who underwent incisional ophthalmic surgery between 1 January 2012 and 30 June 2017 and were included in Optum’s de-identified Clinformatics Data Mart database.

New persistent opioid use was defined as filling an opioid prescription in the 90-day and the 91- to 180-day periods following surgery. An initial perioperative opioid prescription fill was the outcome variable.

The authors calculated the rates of new persistent opioid use and used multivariable logistic regression models to identify variables that elevated the risk of new persistent use and refill of an opioid prescription after the initial perioperative prescription in the first 30 days.

Of the included patients, 14,841 (4.5 percent) had an initial perioperative opioid fill. The rate of new persistent opioid use was 3.4 percent (498/14,841) compared with 0.6 percent (1,833/312,538) in those who did not have an initial perioperative opioid fill.

After adjusting for patient characteristics, initial perioperative opioid fill independently predicted the likelihood of new persistent use (adjusted odds ratio [AOR], 6.21, 95 percent confidence interval [CI], 5.57–6.91; p<0.001).

In addition, among patients who had filled an initial perioperative prescription, a prescription size of ≥150 morphine milligram equivalents correlated with higher odds of refill (AOR, 1.87, 95 percent CI, 1.58–2.22; p<0.001).

“Surgeons should be aware of … risks to identify at-risk patients given the current national opioid crisis and to minimize prescribing opioids when possible,” the authors said.