Swenson CW, et al. - Researchers sought to determine a data-driven definition of new persistent opioid use among opioid naïve women undergoing hysterectomy. The prevalence of and risk factors for new persistent opioid use were also determined. They defined “new persistent opioid use” as ≥ 2 opioid fills within six months of hysterectomy with ≥ 1 fill every three months, and either total oral morphine equivalent ≥ 1,150 or days’ supplied ≥ 39. Considering this definition, they noted a low prevalence of new persistent opioid use among opioid naïve women undergoing hysterectomy, however, preoperative opioid prescription and abdominal route of surgery were identified as the potentially modifiable risk factors.

Methods

• Data from Optum Clinformatics was included; the data includes both medical and pharmacy data from a single national private health insurer.
• Using Current Procedural Terminology and International Classification of Diseases, Ninth Revision codes, researchers identified hysterectomies performed from January 1, 2011 to December 31, 2014.
• For this study, criteria for inclusion included: age ≤ 63 years at hysterectomy, no opioid fills for eight months preceding (excluding the 30 days immediately prior), and no additional surgical procedures within six months post-hysterectomy.
• Thirty days prior to 14 days after hysterectomy defined the perioperative period.
• Researchers analyzed number of opioid prescription fills, days supplied, and total oral morphine equivalents to assess the distribution of opioid use in the perioperative and postoperative periods.
• Based on the U.S. Census Bureau and used International Classification of Diseases, Ninth Revision diagnosis codes, they obtained demographics including age, race, educational level, and division of the country to identify hysterectomy indications, surgical route, chronic pain disorders, depression/anxiety, and substance abuse.
• Using bivariate analyses, they compared persistent to non-persistent opioid users.
• Factors associated with new persistent opioid use following hysterectomy were assessed using a hierarchical logistic regression model controlling for regional variation.

Results

• Researchers included 24,331 women in the analysis.
• The prevalence of new persistent opioid use was 0.5% (N=122) as per the definition.
• In this study, median perioperative oral morphine equivalents (OME) prescribed to those who became new persistent users was 437.5 mg (IQR 200, 750) compared to 225 mg (IQR 150, 300) for non-persistent users (p < .0001).
• New persistent opioid use was noted in independent association with the following factors: increasing age (aOR 1.04, 95% CI 1.01-1.06, p=.006), black race (ref: white, aOR 1.61 95% CI 1.02-2.55, p=.04), gynecologic malignancy (aOR 7.61, 95% CI 3.35-17.27, p < .0001), abdominal route (aOR 3.61, 95% CI 2.03-6.43, p < .0001), depression/anxiety (aOR 2.62, 95% CI 1.71-4.02, p < .0001), and preoperative opioid fill (aOR 2.76, 95% CI 1.87-4.07, p < .0001).
• For this model, C-statistic is 0.74.