Table 1.
Demographic and clinical characteristics for cholecystectomy, SC Medicaid 2014–2017
| Measure | Level | Chronic⁎ | Nonchronic | Total | P value |
|---|---|---|---|---|---|
| Unique patients, n (%) | 1858 (38.8%) | 2930 (61.2%) | 4788 | <.0001 | |
| Age | Mean (SD) | 37.8 (13.0) | 33.1 (12.6) | 34.9 (12.9) | |
| Age category, n (%) | 18–34 y | 896 (48.2%) | 1884 (64.3%) | 2780 (58.1%) | <.0001 |
| 35–54 y | 711 (38.3%) | 819 (28.0%) | 1530 (32.0%) | ||
| 55–64 y | 199 (10.7%) | 162 (5.5%) | 361 (7.5%) | ||
| 65 + y | 52 (2.8%) | 65 (2.2%) | 117 (2.4%) | ||
| Sex, n (%) | Male | 264 (14.2%) | 272 (9.3%) | 536 (11.2%) | <.0001 |
| Female | 1594 (85.8%) | 2658 (90.7%) | 4252 (88.8%) | ||
| Race ethnicity, n (%) | White | 1061 (57.1%) | 1517 (51.8%) | 2578 (53.8%) | |
| Black | 545 (29.3%) | 1072 (36.7%) | 1617 (33.8%) | ||
| Hispanic | 32 (1.7%) | 83 (2.8%) | 115 (2.4%) | ||
| Unknown/other | 220 (11.8%) | 258 (8.8%) | 478 (10.0%) | ||
| Baseline measures (90 d presurgery period), n (%) | |||||
| Opioid naive† | 0 d | 592 (27.1%) | 1592 (72.9%) | 2184 (45.6%) | <.0001 |
| Opioid use during 30 d before surgery | > 0–49 MME/d | 1146 (46.3%) | 1330 (53.7%) | 2476 (95.1%) | <.0001 |
| 50–89 MME/d | 77 (92.8%) | 6 (7.2%) | 83 (3.2%) | ||
| ≥ 90MME/d | 43 (95.6%) | 2 (4.4%) | 45 (1.7%) | ||
| Total | 1266 (48.6%) | 1338 (51.3%) | 2604 (100%) | ||
| Prescriber type for opioids ≤ 14 d before surgery‡‡ | Emergency department | 205 (40.4%) | 303 (59.7%) | 508 (40.7%) | <.0001 |
| Primary care provider | 242 (65.2%) | 129 (34.8%) | 371 (29.7%) | <.0001 | |
| Surgery | 156 (50.5%) | 153 (49.5%) | 309 (24.8%) | .65 | |
| Other | 129 (62.6%) | 77 (37.4%) | 206 (16.5%) | .0005 | |
| Total | 644 (51.6%) | 604 (48.4%) | 1248 (100%) | ||
| Opioid use | |||||
| Mean opioid days [mean (SD)] | 90 d presurgery‡ | 22.8 (31.2) | 3.8 (9.4) | 11.2 (22.8) | <.0001 |
| Exposure period⁎⁎ | 10.8 (10.2) | 4.6 (4.3) | 7.0 (7.8) | <.0001 | |
| ≥ 90 d postsurgery | 48.7 (60.8) | 0 | 18.9 (44.7) | <.0001 | |
| Mean MME [mean (SD)] | 90 d presurgery | 11.8 (26.6) | 1.7 (6.1) | 5.9 (18.5) | <.0001 |
| Exposure period | 18.7 (28.6) | 6.9 (6.8) | 11.5 (19.5) | <.0001 | |
| ≥ 90 d postsurgery | 13.3 (27.9) | 0 (0) | 5.6 (19.3) | <.0001 | |
| Percent with opioid use | 90 d presurgery | 68.1% | 45.7% | 54.4% | <.0001 |
| Exposure period | 88.1% | 81.3% | 83.9% | <.0001 | |
| ≥ 90 d postsurgery | 100.0% | 0.0% | 38.7% | <.0001 | |
| Other medications or alternative pain treatments during exposure period, n (%) | |||||
| NSAIDS, APAP | 208 (11.2%) | 179 (6.1%) | 387 (8.1%) | <.0001 | |
| Antidepressants | 323 (17.4%) | 245 (8.4%) | 568 (11.9%) | <.0001 | |
| Antipsychotics | 78 (4.2%) | 54 (1.8%) | 132 (2.8%) | <.0001 | |
| Gabapentin | 144 (7.8%) | 47 (1.6%) | 191 (4.0%) | <.0001 | |
| Pregabalin | 29 (1.6%) | 3 (0.1%) | 32 (0.7%) | <.0001 | |
| Benzodiazepines | 275 (14.8%) | 114 (3.9%) | 389 (8.1%) | <.0001 | |
| Selected sedatives/hypnotics†† | 77 (4.1%) | 65 (2.2%) | 142 (3.0%) | .0002 | |
| Muscle relaxants | 140 (7.5%) | 57 (2.0%) | 197 (4.1%) | <.0001 | |
| Duloxetine | 39 (2.1%) | 21 (0.7%) | 60 (1.3%) | <.0001 | |
| Alternative pain treatments | Physical therapy | 25 (0.5%) | 17 (0.6%) | 42 (0.9%) | .007 |
| Occupational therapy | 8 (0.4%) | 7 (0.2%) | 15 (0.3%) | .18 | |
| Surgery and process of care variables | |||||
| Rehospitalization, n (%) | ≤ 30 d of discharge | 87 (4.7%) | 95 (3.2%) | 182 (3.8%) | .01 |
| 31–270 d postdischarge | 329 (17.7%) | 143 (4.9%) | 472 (9.9%) | <.0001 | |
| Skilled nursing and Rehab facilities, n (%) | 2 (0.04%) | 2 (0.1%) | 4 (0.1%) | .64 | |
| Hospital length of stay, n (%) | 2 or more nights | 980 (52.7%) | 1535 (52.4%) | 2515 (52.5%) | .81 |
| 1 night or same day | 878 (47.3%) | 1395 (47.6%) | 2273 (47.7%) | ||
| No. unique providers visited (claims data) | Mean (SD) | 1.3 (2.1) | 0.8 (1.5) | 1.0 (1.7) | <.0001 |
| No. distinct prescribers (pharmacy data) | Mean (SD) | 1.3 (0.8) | 0.9 (0.6) | 1.07 (0.7) | <.0001 |
| No. unique nonprescribers visited | Mean (SD) | 0.03 (0.2) | 0.02 (0.15) | 0.03 (0.2) | .10 |
⁎
Use of opioids ≥ 90 days after discharge from procedure is the measure of "chronic use."
†
Opioid-naive for analyses defined as 0 opioid day during 90 days prior to surgery.
‡
Presurgical period = 90 days prior to procedure.
⁎⁎
Exposure period = 30 days after discharge from procedure.
††
This category included nonbenzodiazepine sedative/hypnotics and selected anxiolytics.
‡‡
Patients with ≥ 1 prescription from given source; patients could have multiple prescribers.