Rates of filled opioid prescriptions for incisional ocular surgery increasing
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The rates of filled opioid prescriptions for all types of incisional ocular surgery increased over time, according to a study.
Researchers evaluated the rates of filled opioid prescriptions, from 1 day before incisional ocular surgery to 7 days after surgery, in patients who underwent procedures from January 2000 to December 2016. Incisional eye surgery was defined as any surgical code with a scleral or corneal incision.
The study cohort included patients from the Clinformatics Data Mart Database (Optum), a large national U.S. insurers administrative medical claims database. A total of 2,407,962 incisional ocular surgeries performed on patients 18 years of age or older were included in the analysis. Of these procedures, 45,776 were associated with filling an opioid prescription.
The lowest rate occurred in the 2000-2001 cohort year, with 671 prescriptions filled. The highest rate occurred in 2014, with 5,559 prescriptions filled. Cataract surgeries had the highest number of opioid prescriptions written at 19,494, but it had the lowest rate of prescriptions filled per surgery at 0.95%.
The overall opioid prescription fill rate was 1.9%, but if cataract surgeries were excluded, the rate increased to 7.57%. Strabismus surgeries had the highest fill rate of any procedure, with 19.52% of prescriptions filled.
Researchers found the years with the highest odds of filling a prescription were 2014, 2015 and 2016 compared with 2000 and 2001 (P < .001). – by Robert Linnehan
Disclosures: Kolomeyer reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
Perspective
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Eric D. Donnenfeld, MD
Cataract surgery is one of the most commonly performed procedures in all of medicine and is arguably one of the most successful. Visual outcomes are excellent but sight-threatening complications do occur. Arguably, the greatest risk factor for complications is a small pupil. Omidria (phenylephrine 1% and ketorolac 0.3% intraocular solution, Omeros) in the balanced salt solution has been shown to prevent pupillary miosis and reduce the risk of cataract surgery complications. In the FDA trials, Omidria was also shown to reduce pain associated with cataract surgery.
In our recent prospective, controlled clinical trial published in Clinical Ophthalmology, we evaluated the use of Omidria vs. standard intracameral epinephrine on intraoperative pain during cataract surgery. Both groups received intracameral lidocaine. Omidria lowered pain scores by nearly 50% while reducing the need for intraoperative opioid analgesics (fentanyl) by approximately 80% compared to conventional treatment. These results have particularly important implications for elderly patients, who not only undergo cataract surgery at far higher rates than other age groups but also are also more sensitive to opioids and are at greater risk for opioid dependence and opioid use disorder.
Ophthalmologists view a successful cataract procedure in terms of postoperative Snellen visual acuity. Patients, however, also judge a procedure based on the clinical experience and the absence of pain. Omidria has been shown in the FDA trials and in this study to have a profound effect on reducing patient discomfort. More importantly, there is currently an opioid epidemic in the United States and reducing the need for and risk of intraoperative opioids as demonstrated by the use of Omidria is important for the safety of our patients.
References:
Donnenfeld ED, et al. Clin Ophthalmol. 2019;doi:10.2147/OPTH.S229515.
Lindstrom RL, et al. Clin Ophthalmol. 2014;doi:10.2147/OPTH.S69710.
Rosenberg ED, et al. Clin Ophthalmol. 2017;doi:10.2147/OPTH.S149581.
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