title: New Persistent Opioid Use After Minor and Major Surgical Procedures in US Adults.
abstract: Despite increased focus on reducing opioid prescribing for long-term pain, little is known regarding the incidence and risk factors for persistent opioid use after surgery.
  
  
  
  To determine the incidence of new persistent opioid use after minor and major surgical procedures.
  
  
  
  Using a nationwide insurance claims data set from 2013 to 2014, we identified US adults aged 18 to 64 years without opioid use in the year prior to surgery (ie, no opioid prescription fulfillments from 12 months to 1 month prior to the procedure). For patients filling a perioperative opioid prescription, we calculated the incidence of persistent opioid use for more than 90 days among opioid-naive patients after both minor surgical procedures (ie, varicose vein removal, laparoscopic cholecystectomy, laparoscopic appendectomy, hemorrhoidectomy, thyroidectomy, transurethral prostate surgery, parathyroidectomy, and carpal tunnel) and major surgical procedures (ie, ventral incisional hernia repair, colectomy, reflux surgery, bariatric surgery, and hysterectomy). We then assessed data for patient-level predictors of persistent opioid use.
  
  
  
  The primary outcome was defined a priori prior to data extraction. The primary outcome was new persistent opioid use, which was defined as an opioid prescription fulfillment between 90 and 180 days after the surgical procedure.
  
  
  
  A total of 36 177 patients met the inclusion criteria, with 29 068 (80.3%) receiving minor surgical procedures and 7109 (19.7%) receiving major procedures. The cohort had a mean (SD) age of 44.6 (11.9) years and was predominately female (23 913 [66.1%]) and white (26 091 [72.1%]). The rates of new persistent opioid use were similar between the 2 groups, ranging from 5.9% to 6.5%. By comparison, the incidence in the nonoperative control cohort was only 0.4%. Risk factors independently associated with new persistent opioid use included preoperative tobacco use (adjusted odds ratio [aOR], 1.35; 95% CI, 1.21-1.49), alcohol and substance abuse disorders (aOR, 1.34; 95% CI, 1.05-1.72), mood disorders (aOR, 1.15; 95% CI, 1.01-1.30), anxiety (aOR, 1.25; 95% CI, 1.10-1.42), and preoperative pain disorders (back pain: aOR, 1.57; 95% CI, 1.42-1.75; neck pain: aOR, 1.22; 95% CI, 1.07-1.39; arthritis: aOR, 1.56; 95% CI, 1.40-1.73; and centralized pain: aOR, 1.39; 95% CI, 1.26-1.54).
  
  
  
  New persistent opioid use after surgery is common and is not significantly different between minor and major surgical procedures but rather associated with behavioral and pain disorders. This suggests its use is not due to surgical pain but addressable patient-level predictors. New persistent opioid use represents a common but previously underappreciated surgical complication that warrants increased awareness.
authors.affiliation: Division of Pain Medicine, Department of Anesthesiology, University of Michigan Medical School, Ann Arbor.|Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor.
authors.forename: Chad M
authors.initials: CM
authors.lastname: Brummett
authors.affiliation: Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor.|Department of Surgery, University of Michigan Medical School, Ann Arbor.
authors.forename: Jennifer F
authors.initials: JF
authors.lastname: Waljee
authors.affiliation: Division of Pain Medicine, Department of Anesthesiology, University of Michigan Medical School, Ann Arbor.
authors.forename: Jenna
authors.initials: J
authors.lastname: Goesling
authors.affiliation: Division of Pain Medicine, Department of Anesthesiology, University of Michigan Medical School, Ann Arbor.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Moser
authors.affiliation: Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor.
authors.forename: Paul
authors.initials: P
authors.lastname: Lin
authors.affiliation: Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor.|Department of Surgery, University of Michigan Medical School, Ann Arbor.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Englesbe
authors.affiliation: Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor.|Department of Psychiatry, University of Michigan Medical School, Ann Arbor.|Injury Research Center, University of Michigan Medical School, Ann Arbor.|Veterans' Affairs Center for Clinical Management Research, Ann Arbor, Michigan.
authors.forename: Amy S B
authors.initials: ASB
authors.lastname: Bohnert
authors.affiliation: Division of Pain Medicine, Department of Anesthesiology, University of Michigan Medical School, Ann Arbor.|Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor.
authors.forename: Sachin
authors.initials: S
authors.lastname: Kheterpal
authors.affiliation: Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor.|Veterans' Affairs Center for Clinical Management Research, Ann Arbor, Michigan.|Michigan Center for Health Analytics and Medical Prediction, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor.
authors.forename: Brahmajee K
authors.initials: BK
authors.lastname: Nallamothu
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D013511:Minor Surgical Procedures; D010149:Postoperative Pain / Q000188:drug therapy*; D063487:Prescription Drug Misuse / Q000706:statistics & numerical data*; D012307:Risk Factors; D013514:Surgical Procedures, Operative; D014481:United States
chemical_list: D000701:Analgesics, Opioid