New Persistent Opioid Use After Inguinal Hernia Repair.
Journal
Annals of surgery
ISSN: 1528-1140
Titre abrégé: Ann Surg
Pays: United States
ID NLM: 0372354
Informations de publication
Date de publication:
01 11 2022
01 11 2022
Historique:
pubmed:
17
10
2020
medline:
12
10
2022
entrez:
16
10
2020
Statut:
ppublish
Résumé
To describe the incidence of new persistent opioid use after inguinal hernia repair as well as its associated risk factors. The development of new persistent opioid use after surgery is a common complication; however, its incidence following inguinal hernia repair has not been described. Given that roughly 800,000 inguinal hernia repairs are performed annually in the USA, any incidence could have profound implications for patients. A retrospective cross-sectional study of the incidence of new persistent opioid use after inguinal hernia repair using a national database of de-identified administrative health claims of opioid-naïve patients undergoing surgery from 2008 to 2016. During the study period, 59,795 opioid-naïve patients underwent inguinal hernia repair and met inclusion criteria. Mean (SD) age was 57.8 (16.1) years and 55,014 (92%) patients were male. Nine hundred twenty-two (1.5%) patients continued filling opioids prescriptions for at least 3 months after surgery. The most significant risk factor for developing new persistent opioid use after surgery was filling an opioid prescription in the 30 days before surgery (odds ratio 4.34, 95% confidence interval 3.75-5.01). These prescriptions were provided by surgeons in 52% of cases and primary care physicians in 16% of cases. Other risk factors for new persistent opioid use included receiving a larger opioid prescription, having more comorbidities, having a major postoperative complication, and certain mental health disorders and pain disorders. After undergoing inguinal hernia repair, 1.5% of patients developed new persistent opioid use. Filling an opioid prescription in the 30 days before surgery had the strongest association with this complication.
Sections du résumé
OBJECTIVE
To describe the incidence of new persistent opioid use after inguinal hernia repair as well as its associated risk factors.
SUMMARY OF BACKGROUND DATA
The development of new persistent opioid use after surgery is a common complication; however, its incidence following inguinal hernia repair has not been described. Given that roughly 800,000 inguinal hernia repairs are performed annually in the USA, any incidence could have profound implications for patients.
METHODS
A retrospective cross-sectional study of the incidence of new persistent opioid use after inguinal hernia repair using a national database of de-identified administrative health claims of opioid-naïve patients undergoing surgery from 2008 to 2016.
RESULTS
During the study period, 59,795 opioid-naïve patients underwent inguinal hernia repair and met inclusion criteria. Mean (SD) age was 57.8 (16.1) years and 55,014 (92%) patients were male. Nine hundred twenty-two (1.5%) patients continued filling opioids prescriptions for at least 3 months after surgery. The most significant risk factor for developing new persistent opioid use after surgery was filling an opioid prescription in the 30 days before surgery (odds ratio 4.34, 95% confidence interval 3.75-5.01). These prescriptions were provided by surgeons in 52% of cases and primary care physicians in 16% of cases. Other risk factors for new persistent opioid use included receiving a larger opioid prescription, having more comorbidities, having a major postoperative complication, and certain mental health disorders and pain disorders.
CONCLUSIONS
After undergoing inguinal hernia repair, 1.5% of patients developed new persistent opioid use. Filling an opioid prescription in the 30 days before surgery had the strongest association with this complication.
Identifiants
pubmed: 33065653
pii: 00000658-202211000-00069
doi: 10.1097/SLA.0000000000004560
pmc: PMC8289484
mid: NIHMS1719646
doi:
Substances chimiques
Analgesics, Opioid
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
e577-e583Subventions
Organisme : AHRQ HHS
ID : K08 HS025778
Pays : United States
Organisme : NIDA NIH HHS
ID : R01 DA042859
Pays : United States
Commentaires et corrections
Type : CommentIn
Type : CommentIn
Informations de copyright
Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors declare no conflicts of interest.
Références
Waljee JF, Li L, Brummett CM, et al. Iatrogenic opioid dependence in the United States: are surgeons the gatekeepers? Ann Surg. 2017;265:728–730.
Howard R, Fry B, Gunaseelan V, et al. Association of opioid prescribing with opioid consumption after surgery in Michigan. JAMA Surg. 2018;154:e184234.
Brummett CM, Waljee JF, Goesling J, et al. New persistent opioid use after minor and major surgical procedures in US adults. JAMA Surg. 2017;152:e170504.
Lee JS, Parashar V, Miller JB, et al. Opioid prescribing after curative-intent surgery: a qualitative study using the theoretical domains framework. Ann Surg Oncol. 2018;25:1843–1851.
Harbaugh CM, Lee JS, Hu HM, et al. Persistent opioid use among pediatric patients after surgery. Pediatrics. 2018;141.
Brescia AA, Waljee JF, Hu HM, et al. Impact of prescribing on new persistent opioid use after cardiothoracic surgery. Ann Thorac Surg. 2019;108:1107–1113.
Santosa KB, Hu HM, Brummett CM, et al. New persistent opioid use among older patients following surgery: a Medicare claims analysis. Surgery. 2020;167:732–742.
Lee JS, Vu JV, Edelman AL, et al. Health care spending and new persistent opioid use after surgery. Ann Surg. 2020;272:99–104.
Florence CS, Zhou C, Luo F, et al. The economic burden of prescription opioid overdose, abuse, and dependence in the United States, 2013. Med Care. 2016;54:901–906.
Hernia Surge G. International guidelines for groin hernia management. Hernia. 2018;22:1–165.
Zendejas B, Ramirez T, Jones T, et al. Trends in the utilization of inguinal hernia repair techniques: apopulation-based study. Am J Surg. 2012;203:313–317. discussion 317.
Montgomery J, Dimick JB, Telem DA. Management of groin hernias in adults: 2018. JAMA. 2018;320:1029–1030.
von Elm E, Altman DG, Egger M, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007;370:1453–1457.
Rajabi A, Dehghani M, Shojaei A, et al. Association between tobacco smoking and opioid use: a meta-analysis. Addict Behav. 2019;92:225–235.
Beta Clinical Classifications Software (CCS) for ICD-10-CM/PCS. Healthcare Cost and Utilization Project (HCUP). Rockville, MD: Agency for Healthcare Research and Quality; 2018, Available at: www.hcup-us.ahrq.-gov/toolssoftware/ccs10/ccs10.jsp.
Weyhe D, Tabriz N, Sahlmann B, et al. Risk factors for perioperative complications in inguinal hernia repair: a systematic review. Innov Surg Sci. 2017;2:47–52.
Jivraj NK, Raghavji F, Bethell J, et al. Persistent postoperative opioid use: a systematic literature search of definitions and population-based cohort study. Anesthesiology. 2020;132:1528–1539.
Becker WC, Fiellin DA, Merrill JO, et al. Opioid use disorder in the United States: insurance status and treatment access. Drug Alcohol Depend. 2008;94:207–213.
Haffajee RL, Lin LA, Bohnert ASB, et al. Characteristics of US counties with high opioid overdose mortality and low capacity to deliver medications for opioid use disorder. JAMA Netw Open. 2019;2:e196373.
Howard R, Waljee J, Brummett C, et al. Reduction in opioid prescribing through evidence-based prescribing guidelines. JAMA Surg. 2018;153:285–287.
Bateman BT, Cole NM, Maeda A, et al. Patterns of opioid prescription and use after cesarean delivery. Obstet Gynecol. 2017;130:29–35.
Peahl AF, Dalton VK, Montgomery JR, et al. Rates of new persistent opioid use after vaginal or cesarean birth among US women. JAMA Netw Open. 2019;2:e197863.
Howard R, Fry B, Gunaseelan V, et al. Association of opioid prescribing with opioid consumption after surgery in Michigan. JAMA Surg. 2019;154:e184234.
Hill MV, McMahon ML, Stucke RS, et al. Wide variation and excessive dosage of opioid prescriptions for common general surgical procedures. Ann Surg. 2017;265:709–714.
Vu JV, Howard RA, Gunaseelan V, et al. Statewide implementation of postoperative opioid prescribing guidelines. N Engl J Med. 2019;381:680–682.
Hill MV, Stucke RS, McMahon ML, et al. An educational intervention decreases opioid prescribing after general surgical operations. Ann Surg. 2018;267:468–472.
Hallway A, Vu J, Lee J, et al. Patient satisfaction and pain control using an opioid-sparing postoperative pathway. J Am Coll Surg. 2019;229:316–322.
Michigan Opioid Prescribing and Engagement Network. Opioid Prescribing Recommendations for Surgery. Available at: https://opioidprescribing.info. Updated February 25, 2020. Accessed March 30, 2020.
Klueh MP, Hu HM, Howard RA, et al. Transitions of care for postoperative opioid prescribing in previously opioid-naive patients in the USA: a retrospective review. J Gen Intern Med. 2018;33:1685–1691.
Hah JM, Bateman BT, Ratliff J, et al. Chronic opioid use after surgery: implications for perioperative management in the face of the opioid epidemic. Anesth Analg. 2017;125:1733–1740.
Lee JS, Hu HM, Edelman AL, et al. New persistent opioid use among patients with cancer after curative-intent surgery. J Clin Oncol. 2017;35:4042–4049.
Vu JV, Cron DC, Lee JS, et al. Classifying preoperative opioid use for surgical care. Ann Surg. 2020;271:1080–1086.