Significant risks associated with filling opioid prescription after ophthalmic surgery
Click Here to Manage Email Alerts
Key takeaways:
- Even short courses of opioids after ophthalmic surgery led to higher rates of hospitalization, overdose, abuse or dependency, and mortality.
- Higher opioid doses affected these outcomes.
Filling an opioid prescription after ophthalmic surgery was associated with higher rates of hospitalization, overdose, abuse or dependency, and mortality, according to a study published in Ophthalmology.
“Even a short course of opioids has the ability to lead to chronic abuse or misuse,” Viengneesee Thao, PhD, MS, assistant professor of health services research at the Mayo Clinic, and colleagues wrote. “Thus, there is concern that the use of an opioid prescription after an ophthalmic procedure may lead to increased rates of drug-related overdoses or hospitalizations.”
To investigate short- and long-term risks — including hospitalization, overdose, dependence and mortality — associated with a post-surgical opioid prescription, Thao and colleagues used the OptumLabs Data Warehouse to identify 1,577,692 patients who underwent ophthalmic surgery between January 2016 and June 2022. Of those, 312,580 (20%) had filled a prescription.
The researchers divided patients into three cohorts, the first of which included matched pairs with and without a prescription. The second included matched opioid-naïve pairs with and without a prescription, while the third included opioid-naïve patients who were matched across three morphine milligram equivalent (MME) groups ( 40, 41-80 and > 80).
Baseline characteristics were similar among all patients and those who filled a prescription (average age, approximately 69 years; 61.5% women; 71.1% white; 54.6% resided in the South; 55.2% had undergone anterior segment surgery).
The researchers reported significantly higher rates of hospitalization, opioid overdose and opioid abuse or dependence at 1, 3 and 6 months after surgery, respectively, among patients who filled a prescription vs. those who did not. Similar results were reported among those who were opioid naïve.
When evaluating MME groups, no differences were reported in short-term outcomes among patients who filled prescriptions at the first two doses ( 40 and 41-80); however, at a higher MME dose (> 80), rates of hospitalization increased at 1, 3 and 6 months, as did opioid abuse or dependency at 6 months.
Analysis up to 6 years after surgery showed that among all patients, filling an opioid prescription was associated with higher rates of all-cause mortality (HR = 1.28), hospitalization (HR = 1.51), opioid overdose (HR = 7.31) and opioid abuse or dependency (HR = 13.05; all P < .001).
In addition, the risk for opioid abuse or dependence rose by 217% among those with an MME prescription between 41 and 80 vs. an MME of 40 or less (HR = 3.17; P < .01) and by 216% for those with an MME of at least 80 vs. an MME of 41 to 80 (HR = 3.16; P < .001). Higher MME prescriptions also were associated with increased mortality and hospitalization over time.
“This study is meant to continue to shed light on the current opioid epidemic from an ophthalmological standpoint but may have implications for other elective surgeries and the need for continued education of both patients and surgeons regarding judicial opioid prescriptions while maintaining patient comfort after surgery,” Thao and colleagues wrote.