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. 2020 Oct;35(10):2917-2924.
doi: 10.1007/s11606-020-06015-6. Epub 2020 Aug 3.

Higher Amounts of Opioids Filled After Surgery Increase Risk of Serious Falls and Fall-Related Injuries Among Older Adults

Katherine B Santosa  1 , Yen-Ling Lai  2 , Chad M Brummett  3 , Jeremie D Oliver  4 , Hsou-Mei Hu  2 , Michael J Englesbe  5 , Emilie M Blair  6 , Jennifer F Waljee  7
Affiliations

Higher Amounts of Opioids Filled After Surgery Increase Risk of Serious Falls and Fall-Related Injuries Among Older Adults

Katherine B Santosa et al. J Gen Intern Med. 2020 Oct.

Abstract

Background: Despite increasing numbers of older adults undergoing surgery and the known risks of opioids, little is known about the potential association between opioid prescribing and serious falls and fall-related injuries after surgery.

Objective: To determine the incidence and risk factors of serious falls and fall-related injuries after elective, outpatient surgery.

Design: Retrospective cohort study of 20% national sample of Medicare claims among beneficiaries ≥ 65 years of age with Medicare Part D claims and who underwent elective outpatient surgery from January 1, 2009, through December 31, 2014.

Participants: Opioid-naïve patients ≥ 65 years undergoing elective, minor, outpatient surgical procedures. The exposure was opioid prescription fills in the perioperative period (i.e., 30 days before up until 3 days after surgery) converted to total oral morphine equivalents (OME) over a period 30 days prior to and 30 days after surgery.

Main measures: Serious falls and fall-related injuries within 30 days after surgery, examined through Poisson regression analysis with reported fall and fall-related injury rates adjusted for potential confounders.

Key results: Among 44,247 opioid-naïve surgical patients, 76.3% filled an opioid prescription in the perioperative period. Overall, 0.62% of patients suffered a serious fall or fall-related injury within 30 days after surgery. Risk factors for serious falls or fall-related injuries after surgery included older age (80-84 years: RR 1.64, 95% CI 1.12-2.40; 85 years and older: RR 1.81, 95% CI 1.25-2.86), female sex (RR 3.04, 95% CI 2.29-4.05), Medicaid eligibility (RR 1.63, 95% CI 1.17-2.26), and higher amounts of opioids filled following surgery (≥ 225 OME: RR 2.29, 95% CI 1.72-3.07).

Conclusions: Serious falls after elective, outpatient surgery are uncommon, but correlated with age, sex, Medicaid eligibility, and the amount of opioids filled in the perioperative period. Judicious prescribing of opioids after surgery is paramount and is an opportunity to improve the safety of surgical care among older individuals.

Keywords: falls; older adults; opioid; surgery.

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Conflict of interest statement

Dr. Santosa reported no biomedical financial interests or potential conflicts of interest. Ms. Lai reported no biomedical financial interests or potential conflicts of interest. Dr. Brummett reported no biomedical financial interests or potential conflicts of interest. Mr. Oliver reported no biomedical financial interests or potential conflicts of interest. Dr. Hu reported no biomedical financial interests or potential conflicts of interest. Dr. Englesbe reported no biomedical financial interests or potential conflicts of interest. Ms. Blair reported no biomedical financial interests or potential conflicts of interest. Dr. Waljee reported no biomedical financial interests or potential conflicts of interest.

Figures

Figure 1
Figure 1
Study design schematic. Washout period to identify comorbidities and previous fills of opioids occurred 365 days to 31 days prior to surgery. Exposure to opioids in the perioperative period was defined as 30 days prior to until 3 days after surgery. Follow-up was evaluated 30 days after surgery. An asterisk indicates that any patient who suffered a fall before they received an opioid prescription was excluded from analysis.
Figure 2
Figure 2
Adjusted rates for serious falls and fall-related injuries (1/10,000). Higher amounts of opioids (as measured by total OME) filled in the perioperative period increased the risk of serious falls and fall-related injuries after surgery.
See this image and copyright information in PMC

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