Chronic Opioid Usage in Surgical Patients in a Large Academic Center

Abstract

Objective: The objective of this study is to investigate the prevalence and disparity of chronic opioid usage in surgical patients and the potential risk factors associated with chronic opioid usage.

Background: Chronic opioid usage is common in surgical patients; however, the characteristics of opioid usage in surgical patients is unclear. In this study, we hypothesize that the prevalence of chronic opioid usage in surgical patients is high, and that significant disparities may exist among different surgical populations.

Methods: Data of opioid usage in outpatients among different surgical services were extracted from the electronic medical record database. Patient demographics, clinical characteristics of sex, age, race, body mass index (BMI), specialty visited, duration of opioid use, and opioid type were collected. Chronic opioid users were defined as patients who had been recorded as taking opioids for at least 90 days determined by the first and last visit dates under opioid usage during the investigation.

Results: There were 79,123 patients included in this study. The average prevalence is 9.2%, ranging from 4.4% to 23.8% among various specialties. The prevalence in orthopedics (23.8%), neurosurgery (18.7%), and gastrointestinal surgery (14.4%) ranked in the top three subspecialties. Major factors influencing chronic opioid use include age, Ethnicitiy, Subspecialtiy, and multiple specialty visits. Approximately 75% of chronic users took opioids that belong to the category II Drug Enforcement Administration classification.

Conclusions: Overall prevalence of chronic opioid usage in surgical patients is high with widespread disparity among different sex, age, ethnicity, BMI, and subspecialty groups. Information obtained from this study provides clues to reduce chronic opioid usage in surgical patients.

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1

Prevalence of chronic opioid usage by specialty. Significant disparity on chronic opioid usage is revealed (P < 0.001). The top three subspecialties with high chronic opioid usage were orthopedics, neurosurgery, and GI surgery.

Figure 2

Disparity in the prevalence of chronic opioid usage in various ethnicities. Significant disparity is revealed (P < 0.001). African American has the highest prevalence of opioid usage. Asians had the lowest prevalence.

Figure 3

Prevalence in chronic opioid usage by age group (P < 0.001).

Figure 4

The prevalence of chronic opioid usage is higher in patients with abnormal BMI as compared with that in patients with normal BMI (*P < 0.001). BMI was categorized as underweight (<18.0), normal (18.0–24.9), overweight (25.0–29.9), or obese (≥30.0). BMI indicates body mass index.