Introduction
Methods
Study setting and design
Surgical procedure selection
Cohort eligibility criteria
Outcome and explanatory variables
Covariates
Statistical analyses
Results
Cohort description
Non-Hispanic White | Hispanic, Any Race | Non-Hispanic, Asian | Non-Hispanic, Black | Non-Hispanic, Other | All Patients | |
---|---|---|---|---|---|---|
N=28,586 | N=16,846 | N=7,819 | N=3,850 | N=4,463 | N=61,564 | |
Sex, n (%)
| ||||||
Male | 4,974 (17.4%) | 2,143 (12.7%) | 793 (10.1%) | 317 (8.2%) | 637 (14.3%) | 8,864 (14.4%) |
Female | 23,612 (82.6%) | 14,703 (87.3%) | 7,026 (89.9%) | 3,533 (91.8%) | 3,825 (85.7%) | 52,699 (85.6%) |
Missing | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | 1 (0.0%) | 1 (0.0%) |
Mean Age, Years (SD)
| 45.4 (16.9) | 36.1 (12.8) | 41.0 (14.0) | 37.9 (14.7) | 38.4 (14.0) | 41.3 (15.7) |
Mean BMI, kg/m
2
(SD)
| 30.4 (6.8) | 32.6 (6.9) | 27.9 (5.3) | 33.9 (8.0) | 31.4 (7.2) | 31.0 (7.0) |
Current smoker, n (%)
| 2,399 (8.4%) | 756 (4.5) | 214 (2.7%) | 443 (11.5%) | 318 (7.1%) | 4,130 (6.7%) |
ASA Physical Status, n (%)
| ||||||
Healthy | 3,696 (12.9%) | 2,092 (12.4%) | 1,297 (16.6%) | 235 (6.1%) | 586 (13.1%) | 7,906 (12.8%) |
Mild Systemic Disease | 17,236 (60.3%) | 10,204 (60.6%) | 5,120 (65.5%) | 2,152 (55.9%) | 2,735 (61.3%) | 37,447 (60.8%) |
Severe Systemic Disease | 6,163 (21.6%) | 3,672 (21.8%) | 978 (12.5%) | 1,264 (32.8%) | 913 (20.5%) | 12,990 (21.1%) |
Incapacitating Disease/Moribund | 240 (0.8%) | 96 (0.6%) | 34 (0.4%) | 38 (1.0%) | 24 (0.5%) | 432 (0.7%) |
Missing | 1,251 (4.4%) | 782 (4.6%) | 390 (5.0%) | 161 (4.2%) | 205 (4.6%) | 2,789 (4.5%) |
Diabetes, n (%)
| 1,753 (6.1%) | 1,287 (7.6%) | 660 (8.4%) | 359 (9.3%) | 347 (7.8%) | 4,406 (7.2%) |
Pain Condition, n (%)
| 13,553 (47.4%) | 4,521 (26.8%) | 1,906 (24.4%) | 1,210 (31.4%) | 1,380 (30.9%) | 22,570 (36.7%) |
Procedure Length, n (%)
| ||||||
<1 h | 20,103 (70.3%) | 12,437 (73.8%) | 5,805 (74.2%) | 2,668 (69.3%) | 3,283 (73.6%) | 44,296 (72.0%) |
1 to 2 h | 6,496 (22.7%) | 3,348 (19.9%) | 1,433 (18.3%) | 812 (21.1%) | 861 (19.3%) | 12,950 (21.0%) |
>2 to 3 h | 1,088 (3.8%) | 466 (2.8%) | 215 (2.7%) | 153 (4.0%) | 126 (2.8%) | 2,048 (3.3%) |
>3 h | 421 (1.5%) | 191 (1.1%) | 102 (1.3%) | 104 (2.7%) | 56 (1.3%) | 874 (1.4%) |
Missing | 478 (1.7%) | 404 (2.4%) | 264 (3.4%) | 113 (2.9%) | 137 (3.1%) | 1,396 (2.3%) |
Median Length of Stay, Days (IQR)
| 1.5 (0.3-3.3) | 2.4 (0.8-3.6) | 3.1 (0.8-4.2) | 3.0 (1.0-4.2) | 2.4 (0.5-4.0) | 2.2 (0.3-3.7) |
Opioid Rx Prior to Admission, n (%)
| 5,688 (19.9) | 2,698 (16.0) | 609 (7.8) | 742 (19.3) | 631 (14.1) | 10,368 (16.8) |
Prior Chronic Opioid Use, n (%)
| 1,321 (4.6%) | 649 (3.9%) | 142 (1.8%) | 197 (5.1%) | 139 (3.1%) | 2,448 (4.0%) |
Opioid Rx Prior to Discharge, n (%)
| 26,011 (91.0%) | 15,187 (90.2%) | 6,676 (85.4%) | 3,369 (87.5%) | 3,899 (87.4%) | 55,142 (89.6%) |
Concurrent benzodiazepine, n (%)
| 249 (0.9%) | 41 (0.2%) | 18 (0.2%) | 13 (0.3%) | 16 (0.4%) | 337 (0.6%) |
Procedure, n (%)
| ||||||
Knee Arthroscopy | 1,754 (6.1%) | 515 (3.1%) | 97 (1.2%) | 104 (2.7%) | 176 (3.9%) | 2,646 (4.3%) |
Total Knee Arthroplasty | 1,358 (4.8%) | 190 (1.1%) | 115 (1.5%) | 70 (1.8%) | 80 (1.8%) | 1,813 (2.9%) |
Lumpectomy +/- SLNB | 3,236 (11.3%) | 697 (4.1%) | 998 (12.8%) | 394 (10.2%) | 293 (6.6%) | 5,618 (9.1%) |
Lap. Cholecystectomy/Appendectomy | 8,959 (31.3%) | 5,299 (31.5%) | 1,713 (21.9%) | 770 (20.0%) | 1,245 (27.9%) | 17,986 (29.2%) |
MIS Gynecological Procedures | 3,505 (12.3%) | 1,781 (10.6%) | 562 (7.2%) | 455 (11.8%) | 496 (11.1%) | 6,799 (11.0%) |
Cesarean Delivery | 9,774 (34.2%) | 8,364 (49.6%) | 4,334 (55.4%) | 2,057 (53.4%) | 2,173 (48.7%) | 26,702 (43.4%) |
Case Type, n (%)
| ||||||
Elective | 16,882 (59.1%) | 8,575 (50.9%) | 4,331 (55.4%) | 2,027 (52.6%) | 2,328 (52.2%) | 34,143 (55.5%) |
Emergent | 2,961 (10.4%) | 2,517 (14.9%) | 945 (12.1%) | 585 (15.2%) | 618 (13.8%) | 7,626 (12.4%) |
Urgent/Trauma | 4,817 (16.9%) | 3,627 (21.5%) | 1,635 (20.9%) | 865 (22.5%) | 1,032 (23.1%) | 11,976 (19.5%) |
Missing | 3,926 (13.7%) | 2,127 (12.6%) | 908 (11.6%) | 373 (9.7%) | 485 (10.9%) | 7,819 (12.7%) |
Median Month-Year, Quarter (IQR)
| 11.0 (6.0-16.0) | 11.0 (6.0-16.0) | 11.0 (7.0-16.0) | 11.0 (7.0-16.0) | 12.0 (7.0-16.0) | 11.0 (6.0-16.0) |
Main descriptive outcomes
Non-Hispanic White | Hispanic, Any Race | Non-Hispanic Asian | Non-Hispanic Black | Non-Hispanic Other | All Patients | |
---|---|---|---|---|---|---|
Pooled Procedures
| N=28,586 | N=16,846 | N=7,819 | N=3,850 | N=4,463 | N=61,564 |
Mean Total MME (SD) | 210.0 (174.7) | 184.9 (124.6) | 176.1 (106.6) | 215.6 (179.6) | 192.5 (170.2) | 197.9 (155.5) |
Median Total MME (IQR) | 150 (120, 225) | 150 (120, 200) | 150 (100, 200) | 150 (150, 250) | 150 (112.5, 225) | 150 (120, 225) |
Mean 5-mg Oxy Pills (SD) | 28.0 (23.3) | 24.7 (16.6) | 23.5 (14.2) | 28.7 (23.9) | 25.7 (22.7) | 26.4 (20.7) |
Median 5-mg Oxy Pills (IQR) | 20 (16, 30) | 20 (16, 26.7) | 20 (13.3, 26.7) | 20 (20, 33.3) | 20 (15, 30) | 20 (16, 30) |
Knee Arthroscopy
|
N = 1,754
|
N = 555
|
N = 97
|
N = 104
|
N = 176
|
N = 2,646
|
Mean Total MME (SD) | 266.4 (221.5) | 263.4 (203.6) | 261.7 (202.0) | 351.6 (270.7) | 256.4 (483.6) | 268.4 (246.3) |
Median Total MME (IQR) | 150 (150, 300) | 200 (150, 300) | 200 (150, 300) | 300 (105, 450) | 150 (150, 290) | 160 (150, 300) |
Mean 5-mg Oxy Pills (SD) | 35.5 (29.5) | 35.1 (27.1) | 34.9 (26.9) | 46.9 (36.1) | 34.2 (64.5) | 35.8 (32.8) |
Median 5-mg Oxy Pills (IQR) | 20 (20, 40) | 26.7 (20, 40) | 26.7 (20, 40) | 40 (14, 60) | 20 (20, 38.7) | 21.3 (20, 40) |
Total Knee Arthroplasty
|
N = 1,358
|
N = 190
|
N = 115
|
N = 70
|
N = 80
|
N = 1,813
|
Mean Total MME (SD) | 597.9 (379.5) | 545.4 (367.3) | 403.7 (233.8) | 604.2 (463.2) | 558.5 (460.2) | 578.6 (381.0) |
Median Total MME (IQR) | 450 (300, 800) | 450 (300, 675) | 375 (247.5, 450) | 525 (375, 750) | 450 (300, 712.5) | 450 (300, 750) |
Mean 5-mg Oxy Pills (SD) | 79.7 (50.6) | 72.7 (49.0) | 53.8 (31.2) | 80.6 (61.8) | 74.5 (61.4) | 77.1 (50.8) |
Median 5-mg Oxy Pills (IQR) | 60 (40, 106.7) | 60 (40, 90) | 50 (33, 60) | 70 (50, 100) | 60 (40, 95) | 60 (40, 100) |
Lumpectomy +/- SLNB
|
N = 3,236
|
N = 697
|
N = 998
|
N = 394
|
N = 293
|
N =5,618
|
Mean Total MME (SD) | 156.3 (110.3) | 160.8 (97.8) | 138.9 (94.7) | 194.1 (139.9) | 155.3 (104.9) | 156.4 (109.0) |
Median Total MME (IQR) | 150 (100, 200) | 150 (100, 200) | 100 (100, 150) | 150 (100, 225) | 150 (100, 200) | 150 (100, 200) |
Mean 5-mg Oxy Pills (SD) | 20.8 (14.7) | 21.4 (13.0) | 18.5 (12.6) | 25.9 (16.7) | 20.7 (14.0) | 20.9 (14.5) |
Median 5-mg Oxy Pills (IQR) | 20 (13.3, 26.7) | 20 (13.3, 26.7) | 13.3 (13.3, 20.8) | 20.8 (13.5, 30) | 20.8 (13.3, 26.7) | 20 (13.3, 26.7) |
Laparoscopic
Appendectomy/Cholecystectomy
|
N = 8,959
|
N = 5,299
|
N = 1,713
|
N = 770
|
N = 1,245
|
N = 17,986
|
Mean Total MME (SD) | 191.9 (131.5) | 175.5 (109.7) | 155.3 (93.2) | 191.4 (230.5) | 176.6 (133.9) | 182.5 (129.0) |
Median Total MME (IQR) | 150 (100, 225) | 150 (100, 200) | 150 (100, 200) | 150 (100, 200) | 150 (100, 200) | 150 (100, 200) |
Mean 5-mg Oxy Pills (SD) | 25.6 (17.5) | 23.4 (14.6) | 20.7 (12.4) | 25.5 (30.7) | 23.5 (17.9) | 24.3 (17.2) |
Median 5-mg Oxy Pills (IQR) | 20 (13.3, 30) | 20 (13.3, 26.7) | 20 (13.3, 26.7) | 20 (13.3, 26.7) | 20 (13.3, 26.7) | 20 (13.3, 26.7) |
MIS Gynecological Procedures
|
N = 3,505
|
N = 1,781
|
N = 562
|
N = 455
|
N = 496
|
N = 6,799
|
Mean Total MME (SD) | 166.2 (115.6) | 166.8 (122.2) | 154.2 (90.2) | 187.0 (132.0) | 160.5 (105.4) | 166.3 (116.1) |
Median Total MME (IQR) | 150 (100, 200) | 150 (100, 180) | 150 (100, 150) | 150 (100, 210) | 150 (100, 150) | 150 (100, 200) |
Mean 5-mg Oxy Pills (SD) | 22.2 (15.4) | 22.2 (16.3) | 20.6 (12.0) | 24.9 (17.6) | 21.4 (14.1) | 22.2 (15.5) |
Median 5-mg Oxy Pills (IQR) | 20 (13.3, 26.7) | 20 (13.3, 24) | 20 (13.3, 20) | 20 (13.3, 28) | 20 (13.3, 20) | 20 (13.3, 26.7) |
Cesarean Delivery
|
N = 9,774
|
N = 8,364
|
N = 4,334
|
N = 2,057
|
N = 2,173
|
N = 26,702
|
Mean Total MME (SD) | 196.2 (110.4) | 183.7 (102.8) | 187.8 (96.9) | 214.9 (124.6) | 195.4 (113.4) | 192.3 (107.7) |
Median Total MME (IQR) | 150 (150, 225) | 150 (135, 200) | 150 (150, 225) | 165 (150, 250) | 150 (150, 225) | 150 (150, 225) |
Mean 5-mg Oxy Pills (SD) | 26.2 (14.7) | 24.5 (13.7) | 25.0 (12.9) | 28.7 (16.6) | 26.1 (15.1) | 25.6 (14.4) |
Median 5-mg Oxy Pills (IQR) | 20 (20, 30) | 20 (18, 26.7) | 20 (20, 30) | 22 (20, 33.3) | 20 (20, 30) | 20 (20, 30) |
Main model outcomes
Exploratory outcomes
Guideline-based prescribing
Non-Hispanic White | Hispanic, Any Race | Non-Hispanic Asian | Non-Hispanic Black | Non-Hispanic Other | All Patients | |
---|---|---|---|---|---|---|
Pooled Procedures
| N=28,586 | N=16,846 | N=7,819 | N=3,850 | N=4,463 | N=61,564 |
Opioid Over-Prescribing, n (%) | 20,281 (71.0%) | 12,186 (72.3%) | 5,978 (76.5%) | 3,092 (80.3%) | 3,263 (72.9%) | 44,880 (72.8%) |
Excess 5-mg Oxycodone Pills* | ||||||
Predicted Mean (SD) | 9.0 (7.7) | 8.5 (6.3) † | 8.7 (6.1) † | 11.9 (7.2) † | 8.9 (6.8) | 9.0 (7.2) |
Predicted Median (IQR) | 8.0 (2.9, 13.8) | 8.2 (2.8, 13.5) | 8.5 (3.9, 13.4) | 11.6 (7.0, 16.8) | 8.5 (3.5, 13.8) | 8.4 (3.3, 13.8) |
Knee Arthroscopy
|
N = 1,754
|
N = 515
|
N = 97
|
N = 104
|
N = 176
|
N = 2,646
|
Opioid Over-Prescribing, n (%) | 844 (48.1%) | 260 (50.1%) | 51 (52.6%) | 70 (67.3%) | 64 (36.4%) | 1,289 (48.7%) |
Excess 5-mg Oxycodone Pills* | ||||||
Predicted Mean (SD) | 5.2 (5.8) | 4.8 (6.0) | 3.9 (5.8) | 9.8 (7.3) | 4.8 (6.0) | 5.2 (6.0) |
Predicted Median (IQR) | 3.5 (0, 8.3) | 2.4 (0, 8.3) | 1.1 (0, 5.0) † | 9.3 (3.5, 15.0) † | 3.0 (0, 7.8) | 3.4 (0, 8.4) |
Total Knee Arthroplasty
|
N = 1,358
|
N = 190
|
N = 115
|
N = 70
|
N = 80
|
N = 1,813
|
Opioid Over-Prescribing, n (%) | 941 (69.3%) | 119 (62.6%) | 52 (45.2%) | 52 (74.3%) | 47 (58.8%) | 1,211 (66.8%) |
Excess 5-mg Oxycodone Pills* | ||||||
Predicted Mean (SD) | 18.2 (18.2) | 17.4 (17.4) | 12.1 (14.2) † | 22.3 (19.9) | 16.1 (17.5) | 17.8 (18.0) |
Predicted Median (IQR) | 12.7 (2.0, 29.7) | 13.1 (2.0, 30.2) | 6.2(0, 22.6) | 19.4 (5.9, 33.1) | 9.6 (0.1, 30.2) | 12.1 (1.8, 29.7) |
Lumpectomy +/- SLNB
|
N = 3,236
|
N = 697
|
N = 998
|
N = 394
|
N = 293
|
N =5,618
|
Opioid Over-Prescribing, n (%) | 2,624 (81.1%) | 589 (84.1%) | 819 (82.1%) | 321 (81.5%) | 239 (81.6%) | 4,592 (81.7%) |
Excess 5-mg Oxycodone Pills* | ||||||
Predicted Mean (SD) | 7.9 (4.2) | 7.6 (4.2) † | 6.5 (3.6) † | 9.4 (4.3) † | 7.8 (4.3) | 7.7 (4.2) |
Predicted Median (IQR) | 7.4 (4.4, 10.7) | 7.3 (3.9, 10.4) | 6.3 (3.6, 9.0) | 9.1 (6.0, 12.1) | 7.1 (4.4, 10.2) | 7.3 (4.3, 10.5) |
Lap. Appendectomy/Cholecystectomy
|
N = 8,959
|
N = 5,299
|
N = 1,713
|
N = 770
|
N = 1,245
|
N = 17,986
|
Opioid Over-Prescribing, n (%) | 3,829 (42.7%) | 1,988 (37.5%) | 545 (31.8%) | 302 (39.2%) | 461 (37.0%) | 7,125 (39.6%) |
Excess 5-mg Oxycodone Pills* | ||||||
Predicted Mean (SD) | 3.0 (3.9) | 2.2 (3.2) † | 1.6 (2.6) † | 4.0 (4.6) † | 2.4 (3.5) † | 2.6 (3.6) |
Predicted Median (IQR) | 1.2 (0, 5.1) | 0 (0, 3.8) | 0 (0, 2.6) | 0 (0, 3.8) | 0 (0, 4.1) | 0.6 (0, 4.5) |
MIS Gynecological Procedures
|
N = 3,505
|
N = 1,781
|
N = 562
|
N = 455
|
N = 496
|
N = 6,799
|
Opioid Over-Prescribing, n (%) | 2,886 (82.3%) | 1,522 (85.5%) | 458 (81.5%) | 395 (86.8%) | 420 (84.7%) | 5,681 (83.6%) |
Excess 5-mg Oxycodone Pills* | ||||||
Predicted Mean (SD) | 10.0 (5.1) | 9.0 (4.85) † | 7.3 (4.4) † | 12.1 (6.4) † | 9.3 (4.8) † | 9.6 (5.2) |
Predicted Median (IQR) | 9.5 (5.7, 13.1) | 8.6 (5.1, 12.3) | 6.9 (4.1, 10.5) | 11.2 (7.3, 15.3) | 9.0 (5.4, 12.4) | 9.0 (5.5, 12.8) |
Cesarean Delivery
|
N = 9,774
|
N = 8,364
|
N = 4,334
|
N = 2,057
|
N = 2,173
|
N = 26,702
|
Opioid Over-Prescribing, n (%) | 9,157 (93.7%) | 7,708 (92.2%) | 4,053 (93.5%) | 1,952 (94.9%) | 2,032 (93.5%) | 24,902 (93.3%) |
Excess 5-mg Oxycodone Pills* | ||||||
Predicted Mean (SD) | 13.9 (4.8) | 12.5 (4.4) † | 12.2 (4.3) † | 15.0 (5.0) † | 12.8 (4.7) † | 13.2 (4.7) |
Predicted Median (IQR) | 14.1 (10.0, 17.5) | 12.5 (8.8, 15.9) | 12.2 (8.8, 15.4) | 15.0 (10.8, 18.7) | 12.6 (8.8, 16.4) | 13.2 (9.4, 16.7) |