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Persistent Opioid Use and High-Risk Prescribing in Body Contouring Patients

Bennett, Katelyn G., M.D., M.S.; Kelley, Brian P., M.D.; Vick, Alexis D., B.S.; Lee, Jay S., M.D.; Gunaseelan, Vidhya, M.S., M.H.A.; Brummett, Chad M., M.D.; Waljee, Jennifer F., M.D., M.S.

Plastic and Reconstructive Surgery: January 2019 - Volume 143 - Issue 1 - p 87-96
doi: 10.1097/PRS.0000000000005084
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Background: Opioid misuse occurs commonly among obese patients and after bariatric surgery. However, the risk of new persistent use following postbariatric body contouring procedures remains unknown.

Methods: The authors examined insurance claims from Clinformatics Data Mart (OptumInsight, Eden Prairie, Minn.) between 2001 and 2015 for opioid-naive patients undergoing five body contouring procedures: abdominoplasty/panniculectomy, breast reduction, mastopexy, brachioplasty, and thighplasty (n = 11,257). Their primary outcomes included both new persistent opioid use, defined as continued prescription fills between 90 and 180 days after surgery, and the prevalence of high-risk prescribing. They used multilevel logistic regression to assess the risk of new persistent use, adjusting for relevant covariates.

Results: In this cohort, 6.1 percent of previously opioid-naive patients developed new persistent use, and 12.9 percent were exposed to high-risk prescribing. New persistent use was higher in patients with high-risk prescribing (9.2 percent). New persistent use was highest after thighplasty (17.7 percent; 95 percent CI, 0.03 to 0.33). Increasing Charlson comorbidity indices (OR, 1.11; 95 percent CI, 1.05 to 1.17), mood disorders (OR, 1.27; 95 percent CI, 1.05 to 1.54), anxiety (OR, 1.41; 95 percent CI, 1.16 to 1.73), tobacco use (OR, 1.22; 95 percent CI, 1.00 to 1.49), neck pain (OR, 1.23; 95 percent CI, 1.04 to 1.46), arthritis (OR, 1.30; 95 percent CI, 1.08 to 1.58), and other pain disorders (OR, 1.36; 95 percent CI, 1.16 to 1.60) were independently associated with persistent use.

Conclusions: Similar to other elective procedures, 6 percent of opioid-naive patients developed persistent use, and 12 percent were exposed to high-risk prescribing practices. Plastic surgeons should remain aware of risk factors and offer opioid alternatives.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

This and Related “Classic” Articles Appear on Prsjournal.com for Journal Club Discussions.Patient Safety CME.Psychosocial Insights for This Article are on Page 94.

Ann Arbor, Mich.; and Toledo, Ohio

From the Section of Plastic Surgery, Departments of Surgery and Orthopedic Surgery, the Section of General Surgery, Department of Surgery, the Department of Anesthesiology, University of Michigan; and the University of Toledo School College of Medicine and Life Sciences.

Received for publication January 11, 2018; accepted July 13, 2018.

Disclosure:Dr. Bennett is currently supported by the National Institute of Dental and Craniofacial Research (1F32DE027604-01). Dr. Waljee is supported by Michigan Department of Health and Human Services (MDHHS) (E20180672-00). No other financial relationships to disclose.

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Jennifer F. Waljee, M.D., M.S., Taubman 2130, 1500 East Medical Center Drive, Ann Arbor, Mich. 48109, filip@med.umich.edu Twitter: @waljeejenn

Copyright © 2018 by the American Society of Plastic Surgeons