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.
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.
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.
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.
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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, email@example.com Twitter: @waljeejenn