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Association Between Payer Type and Risk of Persistent Opioid Use After Surgery.
Srinivasan, Sudharsan; Gunaseelan, Vidhya; Jankulov, Alexandra; Chua, Kao-Ping; Englesbe, Michael; Waljee, Jennifer; Bicket, Mark; Brummett, Chad M.
Afiliação
  • Srinivasan S; Department of Anesthesiology, University of Michigan, Ann Arbor, MI.
  • Gunaseelan V; Department of Anesthesiology, University of Michigan, Ann Arbor, MI.
  • Jankulov A; Michigan Opioid Prescribing Engagement Network, Ann Arbor, MI.
  • Chua KP; Oakland University William Beaumont School of Medicine, Oakland University, Rochester Hills, MI.
  • Englesbe M; Department of Pediatrics, Susan B. Meister Child Health and Evaluation Research Center, University of Michigan, Ann Arbor, MI.
  • Waljee J; Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI.
  • Bicket M; Michigan Opioid Prescribing Engagement Network, Ann Arbor, MI.
  • Brummett CM; Department of Surgery, University of Michigan, Ann Arbor, MI.
Ann Surg ; 278(6): e1185-e1191, 2023 12 01.
Article em En | MEDLINE | ID: mdl-37334751
OBJECTIVE: To assess whether the risk of persistent opioid use after surgery varies by payer type. BACKGROUND: Persistent opioid use is associated with increased health care utilization and risk of opioid use disorder, opioid overdose, and mortality. Most research assessing the risk of persistent opioid use has focused on privately insured patients. Whether this risk varies by payer type is poorly understood. METHODS: This cross-sectional analysis of the Michigan Surgical Quality Collaborative database examined adults aged 18 to 64 years undergoing surgical procedures across 70 hospitals between January 1, 2017 and October 31, 2019. The primary outcome was persistent opioid use, defined a priori as 1+ opioid prescription fulfillment at (1) an additional opioid prescription fulfillment after an initial postoperative fulfillment in the perioperative period or at least 1 fulfillment in the 4 to 90 days after discharge and (2) at least 1 opioid prescription fulfillment in the 91 to 180 days after discharge. The association between this outcome and payer type was evaluated using logistic regression, adjusting for patient and procedure characteristics. RESULTS: Among 40,071 patients included, the mean age was 45.3 years (SD 12.3), 24,853 (62%) were female, 9430 (23.5%) were Medicaid-insured, 26,760 (66.8%) were privately insured, and 3889 (9.7%) were covered by other payer types. The rate of POU was 11.5% and 5.6% for Medicaid-insured and privately insured patients, respectively (average marginal effect for Medicaid: 2.9% (95% CI 2.3%-3.6%)). CONCLUSIONS: Persistent opioid use remains common among individuals undergoing surgery and higher among patients with Medicaid insurance. Strategies to optimize postoperative recovery should focus on adequate pain management for all patients and consider tailored pathways for those at risk.
Assuntos

Texto completo: 1 Coleções: 01-internacional Contexto em Saúde: 2_ODS3 / 8_ODS3_consumo_sustancias_psicoactivas Base de dados: MEDLINE Assunto principal: Analgésicos Opioides / Transtornos Relacionados ao Uso de Opioides Tipo de estudo: Etiology_studies / Risk_factors_studies Limite: Adult / Female / Humans / Male / Middle aged País/Região como assunto: America do norte Idioma: En Revista: Ann Surg Ano de publicação: 2023 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Contexto em Saúde: 2_ODS3 / 8_ODS3_consumo_sustancias_psicoactivas Base de dados: MEDLINE Assunto principal: Analgésicos Opioides / Transtornos Relacionados ao Uso de Opioides Tipo de estudo: Etiology_studies / Risk_factors_studies Limite: Adult / Female / Humans / Male / Middle aged País/Região como assunto: America do norte Idioma: En Revista: Ann Surg Ano de publicação: 2023 Tipo de documento: Article