Trends in the Use of Gabapentinoids and Opioids in the Postoperative Period Among Older Adults - PubMed (original) (raw)

Tasce Bongiovanni et al. JAMA Netw Open. 2023.

Erratum in

Abstract

Importance: In response to the opioid epidemic, recommendations from some pain societies have encouraged surgeons to embrace multimodal pain regimens with the intent of reducing opioid use in the postoperative period, including by prescribing gabapentinoids.

Objective: To describe trends in postoperative prescribing of both gabapentinoids and opioids after a variety of surgical procedures by examining nationally representative Medicare data and further understand variation by procedure.

Design, setting, and participants: This serial cross-sectional study of gabapentinoid prescribing from January 1, 2013, through December 31, 2018, used a 20% US Medicare sample. Gabapentinoid-naive patients 66 years or older undergoing 1 of 14 common noncataract surgical procedures performed in older adults were included. Data were analyzed from April 2022 to April 2023.

Exposure: One of 14 common surgical procedures in older adults.

Main outcomes and measures: Rate of postoperative prescribing of gabapentinoids and opioids, defined as a prescription filled between 7 days before the procedure and 7 days after discharge from surgery. Additionally, concomitant prescribing of gabapentinoids and opioids in the postoperative period was assessed.

Results: The total study cohort included 494 922 patients with a mean (SD) age of 73.7 (5.9) years, 53.9% of whom were women and 86.0% of whom were White. A total of 18 095 patients (3.7%) received a new gabapentinoid prescription in the postoperative period. Of those receiving a new gabapentinoid prescription, 10 956 (60.5%) were women and 15 529 (85.8%) were White. After adjusting for age, sex, race and ethnicity, and procedure type in each year, the rate of new postoperative gabapentinoid prescribing increased from 2.3% (95% CI, 2.2%-2.4%) in 2014 to 5.2% (95% CI, 5.0%-5.4%) in 2018 (P < .001). While there was variation between procedure types, almost all procedures saw an increase in both gabapentinoid and opioid prescribing. In this same period, opioid prescribing increased from 56% (95% CI, 55%-56%) to 59% (95% CI, 58%-60%) (P < .001). Concomitant prescribing also increased from 1.6% (95% CI, 1.5%-1.7%) in 2014 to 4.1% (95% CI, 4.0%-4.3%) in 2018 (P < .001).

Conclusions and relevance: The findings of this cross-sectional study of Medicare beneficiaries suggest that new postoperative gabapentinoid prescribing increased without a subsequent downward trend in the proportion of patients receiving postoperative opioids and a near tripling of concurrent prescribing. Closer attention needs to be paid to postoperative prescribing for older adults, especially when using multiple types of medications, which can have adverse drug events.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Bongiovanni reported receiving grant funding from the National Institutes of Health (NIH) and Robert Wood Johnson Foundation during the conduct of the study. Dr Finlayson reported being a founder of Ooney Inc outside the submitted work. Dr Ross reported receiving grant funding from the US Food and Drug Administration, Johnson & Johnson, Medical Device Innovation Consortium, the Agency for Healthcare Research and Quality (AHRQ), the National Heart, Lung, and Blood Institute (NHLBI) of the NIH, and Arnold Ventures LLC outside the submitted work and testifying as an expert witness at the request of the relator’s attorneys, the Greene Law Firm, in a qui tam suit alleging violations of the False Claims Act and Anti-Kickback Statute against Biogen Inc that was settled September 2022. Dr Harrison reported receiving grant funding from the National Institute on Aging (NIA) of the NIH and nonfinancial support from the National Center for Advancing Translational Sciences (NCATS) during the conduct of the study. Dr Steinman reported receiving grant funding from the NIH during the conduct of the study; royalties from UpToDate for chapter authorship; honoraria for guideline development from American Geriatrics Society outside the submitted work; and serving as an unpaid expert witness in litigation that alleged illegal marketing of gabapentin for off-label uses. No other disclosures were reported.

Figures

Figure 1.

Figure 1.. Rate of New Postoperative Gabapentinoid Prescribing Over Time

Error bars indicate 95% CIs.

Figure 2.

Figure 2.. Rate of Postoperative Opioid Prescribing Over Time

Error bars indicate 95% CIs. OME indicates oral morphine equivalents.

Figure 3.

Figure 3.. Estimated Gabapentinoid and Opioid Prescriptions by Procedure Over Time

Error bars indicate 95% CIs. OME indicates oral morphine equivalents.

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