This population-based cohort study assesses the prevalence of immediate and long-term postoperative opioid use after plastic and reconstructive surgery procedures.
Key Points
Question
How common is persistent opioid use after plastic and reconstructive surgery procedures?
Findings
In this population-based cohort study of 466 677 patients who underwent plastic and reconstructive surgery procedures, patients who filled opioid prescriptions perioperatively were at increased risk of persistent opioid use compared with those who did not. This was particularly true for patients who underwent breast and abdominal procedures, as well as those with a history of mental health diagnoses, substance use, and chronic pain.
Meaning
Patients who fill opioid prescriptions in the perioperative period after plastic and reconstructive surgery procedures are at risk for persistent opioid use, and patients with certain comorbidities, characteristics, and procedure types are at highest risk.
Abstract
Importance
Although the development of persistent opioid use after surgical procedures has garnered much attention in recent years, large-scale studies characterizing patterns of persistent opioid use among patients undergoing plastic and reconstructive surgery procedures are lacking.
Objective
To assess the prevalence of immediate and long-term postoperative opioid use after plastic and reconstructive surgery procedures.
Design, Setting, and Participants
In this population-based cohort study, patients who underwent 5 classes of plastic and reconstructive procedures (nasal, eye, breast, abdomen, and soft tissue reconstruction) between January 1, 2007, and December 31, 2015, were identified using IBM MarketScan Commercial and Medicare Supplemental research databases. Patients were excluded if they were younger than 18 years, lacked continuous insurance coverage for 1 year preoperatively and postoperatively, had a second anesthesia event within 1 year postoperatively, and filled an opioid prescription within the year prior to surgery.
Main Outcomes and Measures
Analgesic prescription patterns in the immediate postoperative period. The primary outcome was rates of persistent opioid use (opioid prescriptions filled 90-180 days postoperatively). The secondary outcome was rates of prolonged opioid use (opioid prescriptions filled 90-180 days postoperatively and again 181-365 days postoperatively). Explanatory variables included patient demographics, procedure type, and relevant comorbidities.
Results
Of the 466 677 patients who met inclusion criteria, 96 397 (45.3%) were men, and the mean (SD) age was 46.8 (17.7) years. Furthermore, 212 387 (54.6%) of the patients filled prescriptions for postoperative analgesics, with 212 387 (91.5%) of analgesic prescriptions filled being for opioids. Persistent opioid use occurred in 30 865 (6.6%) patients (5.1%-13.5% across procedure classes), while prolonged opioid use occurred in 10 487 (2.3%) patients (1.7%-5.6% across procedure classes). Patients who filled prescriptions for opioids in the perioperative period were significantly more likely to exhibit persistent (odds ratio [OR], 2.87; 95% CI, 2.80-2.94) and prolonged (OR, 2.90; 95% CI, 2.77-3.02) opioid use than those who did not fill perioperative opioid prescriptions, with the greatest odds for persistent use found in patients who underwent breast (OR, 4.36; 95% CI, 4.10-4.63) and nasal (OR, 3.51; 95% CI, 3.30-3.73) procedures. On multivariable logistic regression analysis, independent risk factors for persistent and prolonged opioid use included perioperative opioid use, procedure type, and prior-year mental health (depression and anxiety) and substance abuse diagnoses.
Conclusions and Relevance
Given the significant risk of persistent opioid use after plastic and reconstructive procedures, it is imperative to develop best practices guidelines for postoperative opioid prescription practices in this population.
Level of Evidence
NA.
Introduction
Opioid dependence has garnered much attention in the media as the rate of opioid dependence and consequent deaths have increased steadily in recent years. Approximately 2.1 million people were affected by an opioid-use disorder and more than 17 000 opioid-related deaths occurred in the United States during 2016.1,2 The latter statistic is particularly harrowing given that approximately 40% of all opioid-related deaths are due to consumption of a prescription opioid.3 There is increasing data that opioid use among patients in the postoperative period is an important risk factor for long-term opioid dependence, with 4.8% to 10.4% of postoperative patients exhibiting persistent postoperative opioid use in the general and pediatric surgical literature.4,5,6 Mental health diagnoses and substance abuse have been shown to be additional risk factors for long-term opioid use among adults undergoing surgical procedures.5,7,8 There is little existing data regarding the rates of persistent postoperative opioid use after plastic and reconstructive procedures, and most evidence consists primarily of smaller case series. Given the elective nature of the majority of these procedures, the risk of opioid dependence is even less acceptable than in patients undergoing procedures to preserve life or mobility.
This retrospective population-based cohort study aimed to determine the incidence of persistent and prolonged opioid use among a cohort of patients who underwent plastic and reconstructive procedures. There was additional aim to assess the association between opioid use, procedure type, and patient demographic factors. In particular, the association of opioid prescription in the immediate postoperative period with long-term opioid use was assessed to determine whether it was an important risk factor for prolonged use as found in the general, orthopedic, and pediatric surgery literature.
Methods
This study was approved by the institutional review board at Stanford University and was determined to be exempt from human subjects review. A retrospective analysis was conducted using insurance claims from the IBM MarketScan Commercial and Medicare Supplemental research databases, a national data set that captures claims made by millions of individuals covered by self-insured employers and other private health plans. Claims were examined from patients 18 years and older who underwent 1 of 5 classes of surgical procedures, determined by Current Procedural Terminology codes (eTable 1 in the Supplement), between January 1, 2007, and December 31, 2015. Procedures included in the study cohort consisted of a variety of nasal, abdominal, oculoplastic, breast, and local tissue reconstructive procedures (eTable 1 in the Supplement). Demographic data was collected, and comorbid diagnoses were identified using International Classification of Diseases, Ninth Revision (ICD-9) and Healthcare Common Procedure Coding System (eTable 2 in the Supplement). Patients were included in the cohort if they had continuous insurance coverage during the 12 months prior to surgery and 12 months after surgery, and had not filled prescriptions for opioids 12 months to 14 days prior to surgery. Patients were excluded from the study if they had an additional anesthetic event within 12 months after the procedure of interest or if they had procedures from more than one procedure class on the day of surgery (eTable 3 in the Supplement).
Perioperative analgesic prescription fills were defined as prescription fills occurring from 14 days prior to surgery through 7 days following surgery. Drug classes included were salicylates, nonsteroidal anti-inflammatory medications, opioids, and miscellaneous analgesic medications. National Drug Codes, dosages, and number of tablets prescribed for each analgesic prescription filled were collected. For patients who received opioids perioperatively, total morphine milligram equivalents were calculated. Opioid prescription fills were recorded for the year after surgery for all patients.
The primary outcome was new persistent opioid use, defined as opioid prescription fills between 90 and 180 postoperative days. A secondary outcome was prolonged opioid use, defined as additional opioid prescription fills 181 to 365 postoperative days among patients with persistent (90-180 postoperative days) opioid use. These outcomes were defined prior to data analysis, and the definition of persistent opioid use was guided by the International Association for the Study of Pain, which describes long-term postoperative pain as persisting for 3 or more months postoperatively.9 Rates of opioid use in the 90- to 180-day and 181- to 365-day postoperative time frames were compared between patients who filled opioids perioperatively and those who did not.
For all patients, a number of sociodemographic and clinical covariates were examined, including age, sex, mental health diagnoses (eg, anxiety, depression, substance abuse disorders), tobacco use, and chronic pain diagnoses within the year prior to surgery. General comorbidity burden was captured using the van Walraven modification of the Elixhauser index, which represents 30 common comorbidities as a numeric score that is closely associated with mortality in the acute setting.10,11
Univariable descriptive statistics were calculated for demographic variables and comorbidities for each surgical class. Distributions of categorical variables were tested using Pearson χ2 testing, with measures of association such as odds ratios (ORs) and 95% CIs also being calculated. A multivariable logistic regression model was used to assess the association between surgical class and both persistent and prolonged opioid use while controlling for patient age, sex, van Walraven index, and prior-year tobacco use, substance abuse, mental health, and pain diagnoses. A stepwise logistic regression (P < .20 for inclusion) was used to identify relevant patient characteristics for inclusion in the final model. Calculated P values were 2-tailed, with statistical significance defined as P < .05. With the exception of calculation of the van Walraven index using R, version 3.4.2 (R Foundation for Statistical Computing), data extraction and statistical analyses were performed using SAS software, version 9.4 (SAS Institute Inc).
Results
A total of 466 677 patients met criteria for inclusion in the study, and the majority of patients underwent nasal and soft tissue reconstructive procedures; descriptive data are summarized in Table 1. Among patients prescribed perioperative opioids, 96 397 (45.3%) patients were men, and the mean (SD) age of the patients examined was 46.8 (17.7) years. The most common comorbid condition among patients who filled postoperative opioid prescriptions was chronic pain (n = 88 680 [39.4%]), followed by substance abuse (n = 28 972 [13.6%]) and anxiety (n = 12 786 [6%]), with increased rates of all of these comorbidities when compared with the cohort who did not receive perioperative opioids (Table 1). Among patients in the study cohort, 232 045 (49.7%) filled prescriptions for postoperative analgesics, and 212 387 (91.5%) of those were prescriptions for opioid medications (Table 2). Perioperative opioid prescription fills were most common among patients who underwent nasal (n = 103 978 [65.7%]) and breast (n = 39 585 [60.8%]) procedures, and least common among those who underwent oculoplastic (n = 14 354 [27.1%]) and soft tissue reconstructive (n = 51 100 [27.6%]) procedures (Table 3). Of note, in more recent years (from 2008 to 2015) there was an overall trend toward prescribing larger amounts of perioperative opioids, which was especially pronounced in patients who underwent breast and nasal procedures; meanwhile, the total amount of opioids prescribed for patients who underwent soft tissue reconstruction and oculoplastic procedures decreased or remained stable (eFigure in the Supplement).
Table 1. Study Population Characteristics.
| Characteristic | No. (%) | |
|---|---|---|
| Filled Perioperative Opioid Prescription | Did Not Fill Perioperative Opioid Prescription | |
| Patient total | 212 387 (54.6) | 254 290 (54.5) |
| Male | 96 397 (45.3) | 118 276 (46.5) |
| Age, mean (SD), y | 46.8 (17.7) | 56.5 (19.2) |
| Region | ||
| Northeast | 34 491 (16.3) | 53 873 (21.2) |
| North Central | 52 082 (24.5) | 56 217 (22.1) |
| South | 84 298 (39.7) | 87 290 (34.3) |
| West | 39 331 (18.5) | 50 506 (19.9) |
| Unknown | 2185 (1.0) | 6846 (2.5) |
| van Walraven index, median (IQR) | 0.0 (0.0-3.0) | 0.0 (0.0-3.0) |
| Prior-year comorbidities | ||
| Anxiety | 12 786 (6.0) | 14 600 (5.8) |
| Depression | 8934 (4.2) | 8919 (3.5) |
| Tobacco use | 7433 (3.5) | 7120 (2.8) |
| Substance abuse | 28 972 (13.6) | 8706 (3.4) |
| Chronic pain | 88 680 (39.4) | 88 283 (34.7) |
| Procedure class | ||
| Nasal | 103 978 (48.9) | 54 258 (21.3) |
| Eye | 14 354 (6.8) | 37 527 (14.8) |
| Breast | 39 585 (18.6) | 25 498 (10.0) |
| Abdomen | 3370 (1.6) | 3040 (1.2) |
| Soft tissue reconstruction | 51 100 (24.1) | 133 967 (52.7) |
Abbreviation: IQR, interquartile range.
Table 2. Postoperative Analgesic Prescription Patterns.
| Analgesic Class | Prescription, No. (%) |
|---|---|
| Salicylate | 270 (0.1) |
| NSAID | 13 465 (5.8) |
| Opioid | 212 387 (91.5) |
| Miscellaneous | 5923 (2.6) |
| Total | 232 045 (100) |
Abbreviation: NSAID, nonsteroidal anti-inflammatory drug.
Table 3. Perioperative, Persistent, and Prolonged Opioid Use Among Procedure Classes.
| Procedure | Opioid Use by Patient, No. (%)a | ||
|---|---|---|---|
| Perioperative | Persistent | Prolonged | |
| All | 212 387 (54.6) | 30 865 (6.6) | 10 487 (2.3) |
| Nasal | 103 978 (65.7) | 9099 (5.8) | 2742 (1.7) |
| Eye | 14 354 (27.1) | 3001 (5.8) | 964 (1.9) |
| Breast | 39 585 (60.8) | 8807 (13.5) | 3645 (5.6) |
| Abdomen | 3370 (52.3) | 562 (8.8) | 247 (3.8) |
| Reconstruction | 51 100 (27.6) | 9396 (5.1) | 2889 (1.6) |
Denominator for all rates is the total number of procedures performed in a given class.
Among the entire cohort of patients filling opioid prescriptions perioperatively, persistent opioid use (90-180 days postoperatively) occurred in 21 334 (10.0%) patients, while prolonged opioid use (with opioid prescription fills both 90-180 days postoperatively and 181-365 days postoperatively) occurred in 7 387 (3.5%) patients. In contrast, only 9 531 (3.8%) patients who did not fill a perioperative opioid prescription filled an opioid prescription 90 to 180 days postoperatively (persistent use), and 3 120 (1.2%) filled an opioid prescription both at 90 to 180 days postoperatively and 181 to 365 days postoperatively (prolonged use) (Table 4).
Table 4. Correlation of Perioperative Opioid Use With Persistent and Prolonged Opioid Use.
| Opioid Use | Patients Undergoing Procedure, No. (%) | |||||
|---|---|---|---|---|---|---|
| All | Nasal | Eye | Breast | Abdomen | Reconstruction | |
| Perioperative opioids | 212 387 (54.6) | 103 978 (65.7) | 14 354 (27.1) | 39 585 (60.8) | 3370 (52.3) | 51 100 (27.6) |
| Persistent Opioid Use | ||||||
| Did not fill perioperative opioid prescriptiona | 9531 (3.8) | 1236 (2.3) | 1773 (4.7) | 1299 (5.1) | 126 (4.1) | 5097 (3.8) |
| Filled perioperative opioid prescriptionb | 21 334 (10.0) | 7863 (7.6) | 1228 (8.6) | 7508 (19.0) | 436 (12.9) | 4299 (8.4) |
| OR (95% CI)c | 2.87 (2.80-2.94) | 3.51 (3.30-3.73) | 1.89 (1.75-2.03) | 4.36 (4.10-4.63) | 3.43 (2.80-4.22) | 2.32 (2.23-2.42) |
| Prolonged Opioid Use | ||||||
| Did not fill perioperative opioid prescriptiona | 3120 (1.2) | 440 (0.8) | 583 (1.5) | 547 (2.1) | 62 (2.0) | 1488 (1.1) |
| Filled perioperative opioid prescriptionb | 7387 (3.5) | 2302 (2.2) | 381 (2.6) | 3098 (7.8) | 185 (5.5) | 1401 (2.7) |
| OR (95% CI)c | 2.90 (2.77-3.02) | 2.77 (2.50-3.07) | 1.73 (1.52-1.97) | 3.87 (3.53-4.25) | 2.79 (2.08-3.73) | 2.51 (2.33-2.70) |
Abbreviation: OR, odds ratio.
Denominator for percentages is the number of patients in each procedure class who did not receive perioperative opioids.
Denominator for percentages is the number of patients in each procedure class who received perioperative opioids.
P < .001.
Among the patient cohort, patients who filled opioid prescriptions in the perioperative period were significantly more likely to exhibit persistent opioid use than those who did not fill opioid prescriptions perioperatively, with the greatest odds found in patients who underwent breast (OR, 4.36; 95% CI, 4.10-4.63) and nasal (OR, 3.51; 95% CI, 3.30-3.73) procedures (Table 4). This was also reflected in a subgroup analysis of patients who underwent the most common nasal procedures (eg, septoplasty, primary rhinoplasty, repair of nasal stenosis), with patients who underwent each procedure type being significantly more likely to exhibit persistent use (OR, 2.48-3.82) if they received opioids perioperatively (eTable 4 in the Supplement).
This trend continued in the prolonged-use category (opioid prescription fills both 90-180 days postoperatively and 181-360 days postoperatively). Across all procedure classes, patients who filled perioperative opioid prescriptions were significantly more likely to display prolonged use (OR, 2.90; 95% CI, 2.77-3.02) (Table 4). Among the various procedure types, this association was largest among patients who underwent breast (OR, 3.87; 95% CI, 3.53-4.25) and abdominal (OR, 2.79; 95% CI, 2.08-3.73) procedures. Subset analysis of patients who underwent the most common nasal procedures again showed that patients who received perioperative opioids had increased odds of prolonged use (OR, 1.73-2.90) (eTable 4 in the Supplement).
Table 5 shows the sociodemographic and procedural factors most closely associated with persistent and prolonged postoperative opioid use on multivariable logistic regression analysis. Some demographic factors had particularly strong associations with persistent opioid use, including a history of depression (adjusted odds ratio [aOR], 1.29; 95% CI, 1.21-1.36), tobacco use (aOR, 1.55; 95% CI, 1.44-1.67), and anxiety (aOR, 1.22; 95% CI, 1.15-1.28). However, breast procedures (aOR, 2.70; 95% CI, 2.59-2.82) and perioperative opioid prescription fills (aOR, 2.71; 95% CI, 2.56-2.86) were most strongly correlated with persistent postoperative opioid use. Similar trends were observed on multivariable logistic regression analysis to determine the relationship between sociodemographic and procedural factors and prolonged opioid use. Again, depression (aOR, 1.16; 95% CI, 1.08-1.25), tobacco use (aOR, 1.39; 95% CI, 1.28-1.51), and anxiety (aOR, 1.39; 95% CI, 1.28-1.51) were correlated with prolonged opioid use. Breast (aOR, 3.29; 95% CI, 3.07-3.53) and abdominal (aOR, 2.27; 95% CI, 1.95-2.65) procedures, along with perioperative opioid use (aOR, 2.68; 95% CI, 2.54-2.83) were most strongly associated with prolonged opioid use.
Table 5. Multivariable Logistic Regression Models for Persistent and Prolonged Opioid Use.
| Model Variable | Opioid Use, aOR (95% CI)a,b | |
|---|---|---|
| Persistent | Prolonged | |
| Age | 1.01 (1.01-1.01) | 1.02 (1.02-1.02) |
| Male | 0.88 (0.85-0.91) | 0.85 (0.80-0.90) |
| Perioperative opioid prescription | 2.71 (2.56-2.86) | 2.68 (2.54-2.83) |
| Perioperative opioid prescription (total MME) | 1.00 (1.00-1.00) | 1.00 (1.00-1.00) |
| Past-year comorbidities | ||
| Depression | 1.29 (1.21-1.36) | 1.16 (1.08-1.25) |
| Anxiety | 1.22 (1.15-1.28) | 1.39 (1.27-1.51) |
| Chronic pain | 1.09 (1.06-1.12) | 1.19 (1.14-1.25) |
| Tobacco use | 1.55 (1.44-1.67) | 1.39 (1.28-1.51) |
| Substance abuse | 1.19 (1.14-1.24) | 1.20 (1.11-1.29) |
| van Walraven index | 1.01 (1.00-1.02) | 1.00 (0.91-1.09) |
| Procedure class | ||
| Nasal | 1.07 (1.02-1.12) | 1.09 (1.01-1.17) |
| Eye | 0.94 (0.89-0.99) | 0.88 (0.79-0.98) |
| Breast | 2.70 (2.59-2.82) | 3.29 (3.07-3.53) |
| Abdomen | 1.68 (1.52-1.86) | 2.27 (1.95-2.65) |
| Reconstruction | 1 [Reference] | 1 [Reference] |
Abbreviations: aOR, adjusted odds ratio; MME, morphine milligram equivalents.
Data presented as aORs (95% CI) unless otherwise noted.
P < .001.
Discussion
In the cohort of 466 677 patients who underwent plastic and reconstructive surgery procedures, approximately half of the patients filled prescriptions for perioperative opioids, which is similar to other surgical populations studied on a large scale.12 In addition, the overall trend toward greater amounts of opioids prescribed from 2008 to 2015 (as measured in morphine milligram equivalents) mirrors other studies displaying a trend toward larger numbers of opioid prescriptions (particularly for more opioids such as oxycodone) among the general population.13 The rate of persistent postoperative opioid use in patients who filled a perioperative opioid prescription varied between 7.6% and 19.0%, which is significantly higher than the commonly reported rates of opioid use of 3% to 11% at least 90 days postoperatively in the general surgery literature.4,6,12,14
Procedure type and perioperative opioid use were the strongest predictors of persistent and prolonged postoperative opioid use, which raises concern that perioperative exposure to opioids in patients undergoing these elective procedures is related to long-term abuse potential. In addition, in a subset analysis of patients who underwent nasal procedures in the present study, perioperative opioid use was correlated with persistent and prolonged use for patients who underwent a particular procedure (eTable 4 in the Supplement), which suggests that this risk is present for patients undergoing any procedure resulting in perioperative opioid use (not just those that would appear to be inherently the most painful). This is particularly important given that 40% of all opioid-related deaths in the United States during 2016 involved the use of a prescription opioid.15 In addition, past-year misuse of prescription opioids has been found to be a strong predictor of heroin abuse, with many heroin users reportedly transitioning from prescription opioids to heroin because of its wide availability and reduced cost when compared with prescription opioids.16,17 The risk of persistent and prolonged opioid use was particularly heightened among patients who underwent breast and abdominal procedures, potentially owing to their more invasive (and possibly more inherently painful) nature. As in other studies, anxiety, depression, substance abuse, and diagnosis of chronic pain were correlated with higher rates of persistent postoperative opioid use.14
Limitations
To our knowledge, this is the first study describing the rates of long-term postoperative opioid use in a population of patients who underwent plastic and reconstructive procedures, and is the only study examining rates of postoperative opioid use up to 1 year postoperatively. However, this study has several limitations. Given the nature of database research, data available for analysis is only as accurate as data coded by medical practitioners who ultimately input diagnosis and procedure codes. In addition, opioid prescription fills were used as a proxy for opioid consumption, which does not account for patients who may have obtained opioids by other means (eg, from friends, family, or other nonmedical sources) or patients who may fill (but never use) a postoperative opioid prescription. This study also does not account for the possibility of drug diversion, a particularly noteworthy threat because hydrocodone and oxycodone (2 opioids that are commonly prescribed in the postoperative setting) comprise the majority of diverted opioids.18 Additionally, nuances of the procedure not coded in the medical record, such as whether factors may cause a given procedure to be more painful (even within a Current Procedural Terminology code class), cannot be assessed, which may be an additional risk factor for persistent opioid use. Finally, this study is composed of patients who underwent functional or reconstructive procedures that were covered by employer-based insurance. Thus, this study does not include patients who underwent cosmetic procedures that were not covered by insurance. Although many of the included procedures (eg, blepharoplasty, repair of nasal stenosis, septoplasty, abdominoplasty, breast reduction) are also commonly performed for purely cosmetic reasons, the functional and reconstructive nature of these procedures may affect the generalizability of these conclusions to the cosmetic population (eTable 1 in the Supplement).
Additionally, the majority of patients in this cohort were prescribed opioid medications (consistent with existing studies), and this in itself is a major risk factor for long-term use.19 One may argue that the use of opioids in these patients was because of the more painful nature of their procedures, because patients who underwent oculoplastic and soft tissue reconstructive procedures had notably lower rates of postoperative opioid use (both immediate and long term). Although this may be true, this still does not account for persistent use beyond 90 days of the procedure and certainly not more than 180 days after the procedure, because patients were excluded if a subsequent surgical procedure was performed. Thus, as perioperative opioid exposure is the greatest risk factor for subsequent long-term use, identifying patients with persistent or prolonged use is necessary, as is implementing strategies to reduce the use of these medications. This study particularly highlights the need for prospective studies to determine the scale of the actual need for postoperative opioid prescriptions (which is expected to vary widely among procedure types), with at least one such prospective study among rhinoplasty patients showing that the vast majority of patients required fewer than 15 tablets of hydrocodone-acetaminophen postoperatively.20 The use of multimodal postoperative pain control and opioid-minimization campaigns have been increasingly described in the general surgery and orthopedic literature with promising results in terms of reduced postoperative pain, decreased opioid consumption, and reduced rates of hospital readmission.21,22,23,24 Similar efforts toward postoperative opioid minimization, including a focus on intraoperative techniques to reduce postoperative pain, have emerged in the field of facial plastic surgery with encouraging results.25,26,27,28 Additional studies of this type are needed in the population undergoing plastic and reconstructive procedures owing to the high rates of long-term postoperative opioid use described in the present study.
Conclusions
Among a cohort of opioid-naïve adults who underwent plastic and reconstructive procedures, a significant proportion of patients exhibited prolonged and persistent opioid use postoperatively. Although certain sociodemographic characteristics were associated with ongoing postoperative opioid use, perioperative opioid use and procedure type were the strongest predictors of opioid use in the year after surgery.
eFigure 1. Temporal Trends in Total Perioperative Opioid Prescriptions
eTable 1. Procedure Classes by Current Procedural Terminology (CPT) Code
eTable 2. Past-Year Comorbidities by ICD-9/HCPCS Code
eTable 3. Anesthesia Events by Current Procedural Terminology (CPT) Code
eTable 4. Subset Analysis: Perioperative Opioid Use Predicts Persistent and Prolonged Opioid Use Among Patients Undergoing Nasal Surgery
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Associated Data
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Supplementary Materials
eFigure 1. Temporal Trends in Total Perioperative Opioid Prescriptions
eTable 1. Procedure Classes by Current Procedural Terminology (CPT) Code
eTable 2. Past-Year Comorbidities by ICD-9/HCPCS Code
eTable 3. Anesthesia Events by Current Procedural Terminology (CPT) Code
eTable 4. Subset Analysis: Perioperative Opioid Use Predicts Persistent and Prolonged Opioid Use Among Patients Undergoing Nasal Surgery