Persistent Opioid Use Among Pediatric Patients After Surgery

Abstract

Background: Despite efforts to reduce nonmedical opioid misuse, little is known about the development of persistent opioid use after surgery among adolescents and young adults. We hypothesized that there is an increased incidence of prolonged opioid refills among adolescents and young adults who received prescription opioids after surgery compared with nonsurgical patients.

Methods: We performed a retrospective cohort study by using commercial claims from the Truven Health Marketscan research databases from January 1, 2010, to December 31, 2014. We included opioid-naïve patients ages 13 to 21 years who underwent 1 of 13 operations. A random sample of 3% of nonsurgical patients who matched eligibility criteria was included as a comparison. Our primary outcome was persistent opioid use, which was defined as ≥1 opioid prescription refill between 90 and 180 days after the surgical procedure.

Results: Among eligible patients, 60.5% filled a postoperative opioid prescription (88 637 patients). Persistent opioid use was found in 4.8% of patients (2.7%-15.2% across procedures) compared with 0.1% of those in the nonsurgical group. Cholecystectomy (adjusted odds ratio 1.13; 95% confidence interval, 1.00-1.26) and colectomy (adjusted odds ratio 2.33; 95% confidence interval, 1.01-5.34) were associated with the highest risk of persistent opioid use. Independent risk factors included older age, female sex, previous substance use disorder, chronic pain, and preoperative opioid fill.

Conclusions: Persistent opioid use after surgery is a concern among adolescents and young adults and may represent an important pathway to prescription opioid misuse. Identifying safe, evidence-based practices for pain management is a top priority, particularly among at-risk patients.

FIGURE 1

Data set construction. The final data set was constructed after excluding patients without continuous insurance enrollment surrounding surgery, with subsequent procedure or anesthesia codes, or opioid prescriptions in the year before surgery. Patients were also excluded if they did not receive a perioperative opioid prescription.

FIGURE 2

Prolonged opioid refills by cohort and surgical procedure. The incidences of prolonged opioid refills (y-axis) among past-year opioid-naïve pediatric patients undergoing surgery, among a control cohort, and individually by procedure (x-axis) are shown.

FIGURE 3

Box-and-whisker plot of the initial prescription total OMEs. Each box represents the 25th to 75th percentiles, with the line representing the median. Outliers were excluded.

FIGURE 4

Average total OMEs prescribed per new prolonged user by postoperative month. The error bar represents 95% of the population.