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Probability of Opioid Prescription Refilling After Surgery: Does Initial Prescription Dose Matter?

Sekhri, Shaina, BS*; Arora, Nonie S., BS*; Cottrell, Hannah, BS*; Baerg, Timothy, BS*; Duncan, Anthony, BS*; Hu, Hsou Mei, PhD; Englesbe, Michael J., MD; Brummett, Chad, MD§; Waljee, Jennifer F., MD

doi: 10.1097/SLA.0000000000002308
Original Articles

Objective: We sought to determine the correlation between the probability of postoperative opioid prescription refills and the amount of opioid prescribed, hypothesizing that a greater initial prescription yields a lower probability of refill.

Background: Although current guidelines regarding opioid prescribing largely address chronic opioid use, little is known regarding best practices and postoperative care.

Methods: We analyzed Optum Insight claims data from 2013 to 2014 for opioid-naïve patients aged 18 to 64 years who underwent major or minor surgical procedures (N = 26,520). Our primary outcome was the occurrence of an opioid refill within 30 postoperative days. Our primary explanatory variable was the total oral morphine equivalents provided in the initial postoperative prescription. We used logistic regression to examine the probability of an additional refill by initial prescription strength, adjusting for patient factors.

Results: We observed that 8.67% of opioid-naïve patients refilled their prescriptions. Across procedures, the probability of a single postoperative refill did not change with an increase with initial oral morphine equivalents prescribed. Instead, patient factors were correlated with the probability of refill, including tobacco use [odds ratio (OR) 1.42, 95% confidence interval (CI) 1.23–1.57], anxiety (OR 1.30, 95% CI 1.15–1.47), mood disorders (OR 1.28. 95% CI 1.13–1.44), alcohol or substance abuse disorders (OR 1.43, 95% CI 1.12–1.84), and arthritis (OR 1.21, 95% CI 1.10–1.34).

Conclusions: The probability of refilling prescription opioids after surgery was not correlated with initial prescription strength, suggesting surgeons could prescribe smaller prescriptions without influencing refill requests. Future research that examines the interplay between pain, substance abuse, and mental health could inform strategies to tailor opioid prescribing for patients.

*Medical Student, University of Michigan Medical School, Ann Arbor, MI

Research Analyst, Michigan Opioid Prescribing Engagement Network, Ann Arbor, MI

Associate Professor, Section of Transplant Surgery Department of Surgery, University of Michigan Health System, Ann Arbor, MI

§Associate Professor, Department of Anesthesiology, University of Michigan Health System, Ann Arbor, MI

Assistant Professor, Section of Plastic Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI.

Reprints: Jennifer F. Waljee, MD, MS, University of Michigan Health System 1500 E. Medical Center Dr, Ann Arbor, MI 48109. E-mail: filip@med.umich.edu.

Funding: Grants include: NIH; NIAMS RO1 AR060392; NIDA 1R01 DA038261–01A1; University of Michigan School Dean's Office- Michigan Genomics Initiative.

Conflict of interest: Dr Waljee receives research funding from the Agency for Healthcare Research and Quality (K08 1K08HS023313–01), the American College of Surgeons, and the American Foundation for Surgery of the Hand; serves as an unpaid consultant for 3 M Health Information systems. Drs Brummett, Englesbe, Waljee, and Hu receive funding from the Michigan Department of Health and Human Services. Dr Brummett reports a patent for Peripheral Perineural Dexmedetomidine licensed to University of Michigan and is a consultant with Tonix. Dr Brummett receives research funding from Neuros Medical Inc. (Willoughby Hills, Ohio). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the Michigan Department of Health and Human Services.

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