Transitions of Care for Postoperative Opioid Prescribing in Previously Opioid-Naïve Patients in the USA: a Retrospective Review

Abstract

Background: New persistent opioid use is a common postoperative complication, with 6% of previously opioid-naïve patients continuing to fill opioid prescriptions 3-6 months after surgery. Despite these risks, it is unknown which specialties prescribe opioids to these vulnerable patients.

Objective: To identify specialties prescribing opioids to surgical patients who develop new persistent opioid use.

Design, setting, and participants: Using a national dataset of insurance claims, we identified opioid-naïve patients aged 18-64 years undergoing surgical procedures (2008-2014) who continued filling opioid prescriptions 3 to 6 months after surgery. We then examined opioid prescriptions claims during the 12 months after surgery, and identified prescribing physician specialty using National Provider Identifier codes.

Main measures: Percentage of opioid prescriptions provided by each specialty evaluated at 90-day intervals during the 12 months after surgery.

Key results: We identified 5276 opioid-naïve patients who developed new persistent opioid use. During the first 3 months after surgery, surgeons accounted for 69% of opioid prescriptions, primary care physicians accounted for 13%, Emergency Medicine accounted for 2%, Physical Medicine & Rehabilitation (PM&R)/Pain Medicine accounted for 1%, and all other specialties accounted for 15%. In contrast, 9 to 12 months after surgery, surgeons accounted for only 11% of opioid prescriptions, primary care physicians accounted for 53%, Emergency Medicine accounted for 5%, PM&R/Pain Medicine accounted for 6%, and all other specialties provided 25%.

Conclusions: Among surgical patients who developed new persistent opioid use, surgeons provide the majority of opioid prescriptions during the first 3 months after surgery. By 9 to 12 months after surgery, however, the majority of opioid prescriptions were provided by primary care physicians. Enhanced care coordination between surgeons and primary care physicians could allow earlier identification of patients at risk for new persistent opioid use to prevent misuse and dependence.

Keywords: care transitions; health services research; patient-centered outcomes research; postoperative care; surgery.

Fig. 1

Prescriber specialty for opioid prescriptions among patients with new persistent opioid use. Among opioid-naïve patients with new persistent opioid use, the majority of postoperative opioid prescribing transitioned from surgeons to primary care clinicians between 3 to 6 months after surgery. Cardiology, Gastroenterology, Oncology, Neurology, and Other provided 25–31% of prescriptions beyond 3 months after surgery. PM&R/Pain Medicine provided less than 6% of prescriptions in the study period. Emergency medicine reached 11% of prescriptions at 6 months after surgery. The highest amount of opioid prescriptions were prescribed in the first 3 months after surgery (n = 8226).