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Care Coordination for Patients on Chronic Opioid Therapy Following Surgery

A Cohort Study

Lagisetty, Pooja MD, MSc*,†,‡; Bohnert, Amy PhD†,‡,§; Goesling, Jenna PhD; Hu, Hsou Mei PhD; Travis, Breanna BS||; Lagisetty, Kiran MD||; Brummett, Chad M. MD; Englesbe, Michael J. MD||; Waljee, Jennifer MD, MSc‡,||

doi: 10.1097/SLA.0000000000003235
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Mini This study sought to examine if early care-coordination between a patient's surgeon and usual prescriber of long-term opioid therapy could mitigate high-risk opioid prescribing following surgery. In this national cohort, 74.3% of chronic opioid users were exposed to episodes of high risk prescribing following surgery. Having a usual preoperative opioid prescriber and visiting this prescriber within 30 days after surgery was associated with decreased odds of having multiple prescribers in the postoperative period.

Objective: To describe if patients with chronic opioid use with a consistent usual prescriber (UP) prior to surgery and if early return to that UP (<30 d) would be associated with fewer high risk prescribing events in the postoperative period.

Summary Background Data: Over 10 million people each year are prescribed opioids for chronic pain. There is little evidence regarding coordination of opioid management and best practices for patients on long-term opioid therapy patients following surgery.

Methods: The study design is a retrospective cohort study. We identified 5749 commercially insured patients aged 18 to 64 with chronic opioid use who underwent elective surgery between January 2008 and March 2015. The predictors were presence of a UP and early return (<30 d from surgery) to a UP. The primary outcome was new high-risk opioid prescribing in the 90-day postoperative period (multiple prescribers, overlapping opioid and/or benzodiazepine prescriptions, new long acting opioid prescriptions, or new dose escalations to > 100 mg OME).

Results: In this cohort, 73.8% of patients were exposed to high risk prescribing postoperatively. Overall, 10% of patients did not have a UP preoperatively, and were more likely to have prescriptions from multiple prescribers (OR 2.23 95% CI 1.75–2.83) and new long acting opioid prescriptions (OR 1.69, 95% CI 1.05–2.71). Among patients with a UP, earlier return was associated with decreased odds of receiving prescriptions from multiple prescribers (OR 0.80, 95% CI 0.68–0.95).

Conclusion: Patients without a UP prior to surgery are more likely to be exposed to high-risk opioid prescribing following surgery. Among patients who have a UP, early return visits may enhance care coordination with fewer prescribers.

*Department of Medicine, University of Michigan, School of Medicine, Ann Arbor, MI

Center for Clinical Management and Research, Ann Arbor, MI

Institute for Health Policy and Innovation, Ann Arbor, MI

§Department of Psychiatry, University of Michigan, School of Medicine, Ann Arbor, MI

Department of Anesthesiology, University of Michigan, School of Medicine, Ann Arbor, MI

||Department of Surgery, University of Michigan, School of Medicine, Ann Arbor, MI.

Reprints: Pooja Lagisetty, MD, MSc, NCRC B16Rm 243, 2800 Plymouth Road, Ann Arbor, MI 48109. E-mail: lagiset@med.umich.edu.

Drs JW, CB, and ME receive funding from the Substance Abuse and Mental Health Services Administration (E20180568-001), and the Michigan Department of Health and Human Services. The content is solely the responsibility of the authors and does not necessarily represent the official views of SAMHSA and the Michigan Department of Health and Human Services.

PL, JW, HMH conceived of the idea, led the analysis, interpretation, drafting, and revision of the manuscript. AB, JG, BT, KL, CB, ME contributed to the concept, interpretation, and revisions of the manuscript.

The authors report no conflicts of interest.

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