Prevalence of Preoperative High-Dose Chronic Opioid Use and Opioid Tapering in Knee, Shoulder, and Spine Surgery

Objective: This study estimates the prevalence of pre-operative high-dose chronic opioid use and subsequent opioid tapering before knee, shoulder, and spine surgery. Methods: We conducted a retrospective review of US commercial claims between February 2014 and December 2016 from Blue Health Intellig...

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Bibliographic Details
Published in:Pain medicine (Malden, Mass.) Mass.), 2019-03, Vol.20 (3), p.594
Main Authors: Muller, Christopher, Watson, Amber R, Blevins Peratikos, Meridith B, Morris, Lindsey C, Stringer, Elizabeth Ann
Format: Article
Language:English
Subjects:
Knee
Shoulder surgery
Spine
Statistics
Surgery
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Summary:Objective: This study estimates the prevalence of pre-operative high-dose chronic opioid use and subsequent opioid tapering before knee, shoulder, and spine surgery. Methods: We conducted a retrospective review of US commercial claims between February 2014 and December 2016 from Blue Health Intelligence. Patients were included in this analysis if they had at least nine months of continuous health coverage (three months preoperative, six months postoperative) surrounding knee, shoulder, or spine surgery. Preoperative high-dose chronic opioid use was defined as a morphine equivalent daily dose (MEDD) greater than 0 mg for at least 60 of the 90 days before surgery and a MEDD greater than 50 mg at any point within 90 days before surgery, indicating candidacy for taper. Opioid tapering was determined by any reduction in MEDD in the 90 days before surgery, with an MEDD lower than the patient's 90-day median on the day before surgery. Results: The prevalence of preoperative high-dose chronic opioid use was 3% for knee surgery, 8% for spine surgery, and 3% for shoulder surgery across 103,857 members. Preoperative opioid tapering in chronic opioid users was evident in 27% of knee surgeries, 23% of shoulder surgeries, and 25% of spine surgeries. Conclusions: The prevalence of preop-erative high-dose chronic opioid use was low in this commercial population. One-fourth of high-dose chronic opioid users underwent an opioid taper before surgery. Further analysis would give insight into the impact of opioid tapering on postoperative medical utilization and outcomes.
ISSN:1526-2375