Higher Amounts of Opioids Filled After Surgery Increase Risk of Serious Falls and Fall-Related Injuries Among Older Adul
- PDF / 412,348 Bytes
- 8 Pages / 595.276 x 790.866 pts Page_size
- 24 Downloads / 160 Views
Section of Plastic Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA; 2Michigan Opioid Prescribing Engagement Network (Michigan OPEN), Ann Arbor, MI, USA; 3Division of Pain Medicine, Department of Anesthesia, University of Michigan Health System, Ann Arbor, MI, USA; 4Mayo Clinic School of Medicine, Rochester, MN, USA; 5Section of Transplantation, Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA; 6Division of General Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, USA.
BACKGROUND: Despite increasing numbers of older adults undergoing surgery and the known risks of opioids, little is known about the potential association between opioid prescribing and serious falls and fall-related injuries after surgery. OBJECTIVE: To determine the incidence and risk factors of serious falls and fall-related injuries after elective, outpatient surgery. DESIGN: Retrospective cohort study of 20% national sample of Medicare claims among beneficiaries ≥ 65 years of age with Medicare Part D claims and who underwent elective outpatient surgery from January 1, 2009, through December 31, 2014. PARTICIPANTS: Opioid-naïve patients ≥ 65 years undergoing elective, minor, outpatient surgical procedures. The exposure was opioid prescription fills in the perioperative period (i.e., 30 days before up until 3 days after surgery) converted to total oral morphine equivalents (OME) over a period 30 days prior to and 30 days after surgery. MAIN MEASURES: Serious falls and fall-related injuries within 30 days after surgery, examined through Poisson regression analysis with reported fall and fall-related injury rates adjusted for potential confounders. KEY RESULTS: Among 44,247 opioid-naïve surgical patients, 76.3% filled an opioid prescription in the perioperative period. Overall, 0.62% of patients suffered a serious fall or fall-related injury within 30 days after surgery. Risk factors for serious falls or fall-related injuries after surgery included older age (80–84 years: RR 1.64, 95% CI 1.12– 2.40; 85 years and older: RR 1.81, 95% CI 1.25–2.86), female sex (RR 3.04, 95% CI 2.29–4.05), Medicaid eligibility (RR 1.63, 95% CI 1.17–2.26), and higher amounts of opioids filled following surgery (≥ 225 OME: RR 2.29, 95% CI 1.72–3.07). CONCLUSIONS: Serious falls after elective, outpatient surgery are uncommon, but correlated with age, sex, Medicaid eligibility, and the amount of opioids filled in the perioperative period. Judicious prescribing of opioids Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11606-020-06015-6) contains supplementary material, which is available to authorized users. Received January 5, 2020 Accepted June 25, 2020
after surgery is paramount and is an opportunity to improve the safety of surgical care among older individuals. KEY WORDS: opioid; surgery; older adults; falls. J Gen Intern Med DOI: 10.1007/s11606-020-06015-6 © Society of General Internal Medicine 2020
INTRO
Data Loading...
