Evidence map›Paper›PMID 35129483›Full record

ArticleAnnals of surgery2023

Surgeon Postoperative Opioid Prescribing Intensity and Risk of Persistent Opioid Use Among Opioid-naive Adult Patients: A Population-based Cohort Study.

Hannah Wunsch, Andrea D Hill, Jennifer Bethell, Longdi Fu, Brian T Bateman, Karim S Ladha, Duminda N Wijeysundera, Mark D Neuman

Open access · greenAbstract read
In one paragraph

Article in Annals of surgery, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
0.8field-weighted citation impact, top 25% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 5 citations in OpenAlex.

  1. Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 6 institutions in 2 countries.

Hannah WunschDepartment of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Andrea D HillDepartment of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Jennifer BethellICES, Toronto, Ontario, Canada.
Longdi FuICES, Toronto, Ontario, Canada.
Brian T BatemanDepartment of Anesthesia, Perioperative, and Pain Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
Karim S LadhaDepartment of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada.
Duminda N WijeysunderaDepartment of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada.
Mark D NeumanDepartment of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
University of Toronto · CAHarvard University · USSt. Michael's Hospital · CASunnybrook Health Science Centre · CASunnybrook Research InstituteUniversity of Pennsylvania · US

Funding

Acute Pain Management and Long-term Opioid Use after SurgeryR01DA042299 · NIDA · SUNNYBROOK RESEARCH INSTITUTE · PI NEUMAN, MARK DAVID, WUNSCH, HANNAH · 2017 to 2020
$2.0M
NIDA NIH HHS R01 DA042299
6 · The paper itself

Abstract

objectiveThe aim of this study was to determine the relationship between surgeon opioid prescribing intensity and subsequent persistent opioid use among patients undergoing surgery. SUMMARY BACKGROUND DATA: The extent to which different postoperative prescribing practices lead to persistent opioid use among surgical patients is poorly understood.

methodsRetrospective population-based cohort study assessing opioid-naive adults who underwent 1 of 4 common surgeries. For each surgical procedure, the surgeons' opioid prescribing intensity was categorized into quartiles based on the median daily dose of morphine equivalents of opioids dispensed within 7 days of the surgical visit for all the surgeons' patients. The primary outcome was persistent opioid use in the year after surgery, defined as 180 days or more of opioids supplied within the year after the index date excluding prescriptions filled within 30 days of the index date. Secondary outcomes included a refill for an opioid within 30 days and emergency department visits and hospitalizations within 1 year.

resultsAmong 112,744 surgical patients, patients with surgeons in the highest intensity quartile (Q4) were more likely to fill an opioid prescription within 7 days after surgery compared with those in the lowest quartile (Q1) (83.3% Q4 vs 65.4% Q1). In the primary analysis, the incidence of persistent opioid use in the year after surgery was rare in both highest and lowest quartiles (0.3% Q4 vs 0.3% Q1), adjusted odds ratio (AOR) of 1.18, 95% CI 0.83-1.66). However, multiple analyses using stricter definitions of persistent use that included the requirement of a prescription filled within 7 days of discharge after surgery showed a significant association with surgeon quartile (up to an AOR 1.36, 95% CI 1.25, 1.47). Patients in Q4 were more likely to refill a prescription within 30 days (4.8% Q4 vs 4.0% Q1, AOR 1.14, 95% CI 1.04-1.24).

conclusionsSurgeons' overall prescribing practices may contribute to persistent opioid use and represent a target for quality improvement. However, the association was highly sensitive to the definition of persistent use used.

Indexed as

Opioid-Related DisordersSurgeonsAdultAnalgesics, OpioidCohort StudiesDrug PrescriptionsHumansPostoperative PainPractice Patterns, Physicians'Retrospective StudiesAnalgesics, Opioid

Identifiers

PMID35129483
PMCPMC9124725
OpenAlexW3216387817

What OpenQuestion holds

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.