TABLE 1.
Characteristics of included studies
| Article | Study Sample Description (N) | Source of Data for Long-Term Use Measure | Definition Summary | Comparison Group | Percent Long-Term Users |
|---|---|---|---|---|---|
| Alghnam64 | Adults (18+) (N = 36 824) | Survey data (Medical Expenditure Panel Survey) | Self-reported opioid use in two of the final three rounds of the Medical Expenditure Panel Survey (totaling 8 mo of time) | Patients without long-term use | 15.60% |
| Anderson65 | Workers’ compensation recipients in Ohio who had lumbar fusion from 1993 to 2013 (N = 1002) | Administrative claims database (Ohio Bureau of Workers’ Compensation) | Post-operative long-term use: starting 6 wk after the surgery, more than 365 days’ opioid supply in the 3-y follow-up period Pre-operative long-term use: 120 days’ opioid supply in the year before surgery. |
Less than 365 days’ supply of opioids in the year following a 6-wk post-operative period. | 575/1002 = 57% |
| Bartels53 | Patients with surgery during October 2011 and September 2013 (N = 6003) | Electronic health record (University of Colorado Hospital) | At least one opioid prescription fill 31 to 180 d after surgery | Patients without long-term prescription | 43.6% |
| Brumett66 | Opioid-naïve, US adults age 19 to 64 with a surgical procedure between 2013 and 2014 (N = 36 177) | Administrative claims data (Clinformatics Data Mart) | At least one opioid prescription fill in each of two time periods: 30 d before through 14 d after surgery and 90–180 d after surgery | Patients without surgery, anesthesia, or an opioid prescription in a 12-mo period | Minor surgery group: 5.9% Major surgery group: 6.5% Nonoperative control group: 0.4% |
| Cancienne49 | Patients who underwent primary total knee arthroplasty from 2007 to the first quarter of 2016 (N = 113 337) | Administrative claims data (Pearldiver patient records) | At least one opioid prescription fill 3 to 6 mo after surgery. | Patients without long-term use | 35 770/113 337 = 32% |
| Connolly67 | US adults with lumbar spinal fusion surgery during 2009 to 2012 (N = 8377) | Administrative claims data (Clinformatics Data Mart) | At least 365 days’ supply in the 2-y follow-up period after surgery. | Patients without long-term opioid use | 29.34% |
| Crocker68 | Patients with Crohn disease and functional gastrointestinal disorder diagnosis from 2006 to 2011 (N = 931) | Electronic medical record (University of Virginia Digestive Health Center) and the prescription monitoring program database (Virginia and West Virginia) | One opioid prescription fill per month for 3 consecutive months in a 12-mo follow-up period or more than two prescription opioid fills in any 6-mo period of the 12-mo follow-up period. | Two groups- Crohn disease with and without functional gastrointestinal disorders | 192/931 = 21% |
| Deyo69 | Patients with lumbar fusion from October 2012 to September 2013 (N = 2491) | Administrative data (Oregon prescription drug monitoring program) | Pre-operative long-term use was at least four opioid prescription fills in the 7 mo before the index date where three fills occur within 180 d before the index date. Post-operative long-term use was at least four opioid prescription fills in 7 mo after the index date with at least three prescriptions 30 d after the hospitalization |
Patients without postoperative long-term opioid use | 12.8% |
| Daoust44 | Canadian adults, age 65+, with a trauma admission from April 2004 to March 2014 (N = 84 241) | Administrative database (Medical Consultations and Medication database in Quebec) | At least one opioid prescription fill 305 to 425 d after hospital discharge | Patients without opioid prescription 1 y after injury. | 4337/39 833 = 10.9% |
| Dunn70 | Patients who received elective spinal fusion from March 2011 to February 2016 (N = 1477) | Electronic health record (University of Virginia) | Documented opioid use at each of the following postoperative time periods: 1–3 d, 1 mo, 6 mo, and 12 mo | Patients without opioid use at 12 mo | (67 + 498)/1477 = 38% |
| Franklin38 | Workers with acute back injury at risk for long-term disability from 2002 to 2004 (N = 1296) | Administrative pharmacy claims data (Washington workers’ compensation medical billing database) | At least one opioid prescription fill in each of four consecutive calendar quarters | Patients with opioid use during fewer than three quarters | 111/1843 = 6.02% |
| Goesling43 | Patients with total knee arthroplasty and total hip arthroplasty from March 2010 to May 2013 (N = 574) | Medical records and confirmation with patients during follow-up (telephone surveys and validated questionnaires) | No explicit definition. Self-reported opioid use was assessed at 30 d, 90 d, and 180 d after surgery. | Patients without opioid use at 6 mo | Not information to calculate rate |
| Fritz71 | Opioid-naïve patients with low back pain from 2012 to 2014 (N = 707) | Administrative data (University of Utah Health Plan) | More than 120 d supply or more than 10 opioid prescription fills with more than 90 d supply during 1-y follow-up. | Patients without long-term use | 24.3% |
| Granadillo48 | Patients with hip arthroscopy from 2007 to 2015 (N = 1708) | Administrative claims data (Pearldiver patient records) | At least one opioid prescription fill 3 to 6 mo after surgery. | Patients without long-term use | 468/1708 = 27.4% |
| Holman45 | Patients with orthopedic trauma from June 2005 to June 2007 (N = 748) | Administrative data (Utah Controlled Substance Database) | No explicit definition. Presence of at least one opioid prescription fill was assessed during three time periods in the 6-mo follow-up period after surgery: 0 to 6 wk, 6 to 12 wk, and more than 12 wk. | Patients without continued use of opioids 6 wk after surgery | LTOT prevalence for more than 12 wk: 19.7% |
| Jain72 | Patients with primary cervical fusion for degenerative pathology from 2007 to the third quarter of 2015 (N = 29,101) | Administrative claims data (Pearldiver Humana database) | Preoperative long-term use is at least one prescription during the following preoperative time periods: 0 to two weeks, 2 wk to 1 mo, 1–3 mo, 3–6 mo, and 6 mo. Postoperative long-term use is at least one prescription during the following postoperative time periods: 0–6 wk, 6 wk to 3 mo, 3–6 mo, 6–9 mo, and 9–12 mo. |
Patients without preoperative long-term use Patients without postoperative long-term use |
49.2% |
| Jiang46 | Adults who received surgical care from 2010 to 2011 (N = 79,123) | Electronic medical record (University of Pennsylvania Health system) | At least 90 d of opioid use between the first and last recorded outpatient visit occurring within a 2-y observation period | Patients without chronic opioid use | 9.2% |
| Johnson37 | Adults with elective and trauma related hand surgery procedures from 2010 to 2012 (N = 77,573) | Administrative data (Truven Market-Scan Commercial Claims Research Database) | At least one opioid prescription fill in each of two time periods: 30 d before through 14 d after surgery and 90–180 d after surgery | Patients without long-term opioid use | Of the opioid naïve patients with a perioperative opioid prescription (N = 59 735), 13% |
| Kim55 | Patients with hip or knee arthroplasty from 2004 to 2013 (N = 57 545) | Administrative data (United Healthcare/Optum Clinformatics Data Mart Database) | Monthly opioid use for 12 consecutive months | Patients without long-term opioid use | 4394/57 545 = 7.6% |
| Koeppe 201173 | Opioid naïve, US Adults with HIV from 11 clinics from 1998 to 2008 (N = 931) | Medical Records (data from the HIV Outpatient Study) | Measured prolonged analgesic use, defined as 90 or more consecutive days of opioid or nonopioid analgesic medication use. | Patients without long-term opioid use | 931/4180 = 22% |
| Kulshrestha74 | Adults who have kidney transplant from 2004 to 2008 (N = 1045) | Electronic medical record (single center study, name not reported) | 1. Opioid use reported during three time periods after surgery: 1–2 mo, 3–6 mo, and 10–12 mo. 2. Opioid use reported during the 1–2-mo and 3–6-mo follow-up period only if patient had a graft loss or died during the 3–12 mo follow-up period |
Patients without long-term opioid use | 119/(119 + 926) = 11% |
| Mosher39 | Patients with an outpatient opioid prescription during FY 2011 that was preceded by a 1-y opioid-free period (N = 43 027) | Administrative data (Veterans Health Administration) | More than 90 days of continuous opioid use (determined by the days’ supply), with the initiation of the episode beginning within the first 30 d of the first prescription. | Patients without long-term use | Medicine: 15.2% Surgery: 5.3% Total sample: 9.10% |
| Mueller50 | Patients with total shoulder arthroplasty and shoulder hemiarthroplasty during 2002 to 2012 (N = 6988) | Administrative claims data (Marketscan) | Preoperative long-term use was more than 10 opioid prescription fills or 120 d opioid supply during the year before surgery. Postoperative long-term use was at least one prescription during the follow-up |
Patients with and without nerve block | 50.1% of patients without nerve block; 49.5% among patients with nerve block |
| Mulligan75 | Patients with ankle or hindfoot reconstruction (N = 132) | Electronic medical record (study site not reported) | Opioid prescription from 90 d to 2 y after surgery | Patients without continued use 90 d after surgery | 35% |
| Namba76 | Patients with unilateral primary total knee arthroplasty from 2008 to 2011 (N = 23 726) | Electronic medical record (Kaiser Permanente Northern California, Southern California, and Hawaii) | No explicit definition. Assessed presence of opioid prescription during each quarter of the follow-up year after surgery. | Patients without an opioid prescription in that quarter (separate models for each quarter) | Days 1–90: 92.7% Days 91–180: 42.1% Days 181–270: 32.2% Days 271–360: 30.4% |
| Pugley51 | Patients with cervical spinal arthrodesis from 2007 to 2014 (N = 17 391) | Administrative data (Humana Inc via PearlDiver) | One or more opioid prescription fill at 1 y after surgery. | Patients without opioid use in the 3 mo before surgery | LTOT at 12 mo: 27.6% |
| Qureshi52 | Patients with discectomy from 2007 to 2015 (N = 1321) | Administrative data (PearlDiver) | Opioid prescription fill 3–6 mo after surgery | Patients without long-term prescription | (621/621 + 700) = 47% |
| Raebel77 | Adults (21+) with bariatric surgery without chronic opioid use before surgery from nine health systems from 2005 to 2009 (N = 10 643) | Electronic medical record (outpatient pharmacy dispensing data) (nine health systems participating in the Scalable Partnering Network (SPAN)) | Ten or more opioid prescription fills over more than 90 d, or more than 120 d opioid supply during 1 y of follow-up More than 120 d supply during the 1-y follow-up. | Patients without chronic opioid use the year after surgery | 4% |
| Ray 201741 | Opioid naïve patients (+19) with at least 1 opioid prescription 2011 (N = 2 480 030) | Electronic medical record (Kaiser Permanente Northern California) | At least 3 mo of opioid use with either more than 120 d opioid supply or 10 or more opioid prescription fills during the 3-y follow-up period. | Cohort of patients without opioid fill in 2011 | 112 089/455 693 = 25% |
| Rosenbloom47 | Adults with musculoskeletal surgery (n = 122) | Patient reported survey (2 large level I trauma centers (Sunnybrook Health Sciences Centre [SHSC] and St. Michael’s Hospital [SMH]), in Toronto, Canada) | Self-reported opioid use in the past week at 4 mo after injury | Patients without opioid prescription at 4 mo after surgery | 35% |
| Rozet54 | US veterans 18 to 50 with elective ambulatory knee arthroscopic surgery from 2007 to October 2010 (N = 145) | Electronic medical record (Veterans Affairs’ Tertiary Medical Center (Seattle Division, VA PSHCS)) | At least 3 mo of “uninterrupted” opioid use after surgery. | Patients with and without post-traumatic stress disorder | 30% |
| Rao78 | Patients with shoulder arthroplasty registry from 2008 to 2014 (N = 4243) | Shoulder Arthroplasty Registry which includes data collected from electronic intraoperative forms, electronic health records, administrative claims, membership data, and mortality records (Kaiser Permanente Hawaii, Northern California, and Southern California | No explicit definition. Assessed presence of opioid prescription during each quarter of the follow-up year after surgery. | Patients without an opioid prescription in that quarter (separate models for each quarter) | Opioid use in the rehabilitation period ranged from 38% to 42% though specific percentages are not reported. |
| Sun42 | Patients with total knee arthroplasty from 2002 to 2012 (N = 120 080) | Administrative claims data (Marketscan) | More than 10 opioid prescription fills or 120 d opioid supply 91–365 d post-surgery | Patients without long-term use | Unable to calculate LTOT |
| Thornton40 | Patients with an opioid prescription from 2007 to May 2015 (N = 491 442) | Administrative Claims Data (IMS Health/Quintiles, IQVIA) | More than 90 d supply during the 4 mo follow up period | Patients without long-term use | 1.30% |