High-Risk Prescribing Increases Rates of New Persistent Opioid Use in Total Hip Arthroplasty Patients

Abstract Background The association between surgeon prescribing practices and new persistent postoperative opioid use is not well understood. We examined the association between surgeon prescribing and new persistent use among total hip arthroplasty (THA) patients. Methods A retrospective analysis of Medicare claims in Michigan was performed. The study cohort consisted of orthopedic surgeons performing THAs from 2013-2016, and their opioid naive patients, ages > 65. High-risk prescribing included: high daily doses, overlapping benzodiazepine prescriptions, concurrent opioid prescriptions, prescriptions from multiple providers, or long-acting opioid prescriptions. The occurrence of a preoperative prescription, initial prescription size, and 30-day prescription dosage were examined as individual exposures. Surgeons were categorized into quartiles by prescribing practices, and a multilevel hierarchical logistic regression examined associations with postoperative new persistent opioid use. Results Surgeons exhibited high-risk prescribing for 66% of encounters. Patients of surgeons with the highest rates of high-risk prescribing were more likely to develop persistent use compared with patients of surgeons with the lowest rates (adjusted rates: 9.7% vs. 4.6%, p=0.011). Patients of surgeons with initial prescription sizes in the ‘high’ (third) quartile (adjusted OR, 2.91; 95% CI, 1.53-5.51), and of surgeons in the ‘highest’ (fourth) quartile of 30-day prescription dosage (adjusted OR, 1.93; 95% CI, 1.03-3.61), were more likely to develop persistent opioid use compared with patients of surgeons with low initial and 30-day prescription sizes, respectively. Conclusions The development of persistent opioid use after surgery is multifactorial, and surgeon prescribing patterns play an important role. Reducing prescribing and encouraging opioid alternatives could minimize postoperative persistent opioid use.