Long-term prescription opioid use following surgery in the US (2017-2022): a population-based study

Andrew J Schoenfeld; Zara Cooper; Amanda Banaag; Jonathan Gong; Matthew R Bryan; Christian Coles; Tracey P Koehlmoos

doi:10.1016/j.lana.2024.100948

Long-term prescription opioid use following surgery in the US (2017-2022): a population-based study

Lancet Reg Health Am. 2024 Dec 4:40:100948. doi: 10.1016/j.lana.2024.100948. eCollection 2024 Dec.

Authors

Andrew J Schoenfeld¹, Zara Cooper², Amanda Banaag³, Jonathan Gong⁴, Matthew R Bryan⁵, Christian Coles⁶, Tracey P Koehlmoos⁶

Affiliations

¹ Center for Surgery and Public Health, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
² Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
³ Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Drive, Bethesda, MD, 20817, USA.
⁴ Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
⁵ Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.
⁶ Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA.

Abstract

Background: Over the last decade, numerous efforts have been made to combat the opioid crisis globally. The impact of these strategies has not been adequately measured and may differ across populations depending on baseline risk. We compared changes in long-term prescription opioid use following surgery within a national US cohort, between 2017 and 2022.

Methods: We used TRICARE claims data to identify individuals undergoing one of 14 representative surgical procedures. The rate of post-operative long-term prescription opioid use during 2020-22 was compared to 2017-19. We used modified Poisson regression analyses to adjust for confounding. We performed secondary analyses that accounted for interactions between the time period and race, pre-operative opioid use, surgical care setting and our proxy for socioeconomic status.

Findings: Our data derived from TRICARE claims. We included 410,326 surgical events. Across both time periods, there were 213,212 females (52%), with a median age of 53 (IQR 22) and 207,188 individuals of White race (50%). The median co-morbidity index was 0 (IQR = 0). The rate of long-term post-operative opioid use was 11% in 2017-19, which reduced to 6% in 2020-22 (risk ratio [RR] 0.51; 95% CI 0.50, 0.52). Reductions were appreciated across all census divisions in the US and across all racial minorities, those of lower socioeconomic background and pre-operative chronic opioid users. Following multivariable analysis, there was a significant reduction in long-term prescription opioid use (RR 0.61; 95% CI 0.60, 0.63) after surgery in 2020-22 as compared to 2017-19.

Interpretation: This investigation represents one of the largest and most comprehensive longitudinal assessments of opioid use following surgery. We found clinically relevant reductions in post-operative prescription opioid use in 2020-22 as compared to 2017-19. Given the representative nature of the study cohort, we believe these results are reflective of national trends.

Funding: U.S. Department of Defense, Defense Health Agency (award # HU00012120089).

Keywords: Epidemiology; Long-term opioid use; Opioid crisis; Risk factors; Socioeconomic status; Surgery.