Characterizing and Reducing New Persistent Opioid Use in Patients Undergoing Complex Major Surgery

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Abstract The opioid epidemic represents a public health crisis that continues to worsen with mortality due to unintentional prescription opioid overdose increasing by 450% over the last two decades. Despite major advancements in the management of chronic pain and opioid prescription practices for chronic pain, prescriptions for acute pain have not declined. Additionally, opioid prescriptions following surgical operations represent a common entry pathway to new persistent opioid use. Our previous work has shown high rates of new persistent opioid use among patients following multiple common outpatient surgical procedures, but investigation into patients after major surgical operations and those that suffer complications from those procedures is lacking. Patients with complicated post-operative courses often undergo repeated procedures and have prolonged lengths of hospital stay, altering the trajectory with which their pain abates and potentially drastically increasing their exposure to post-operative opioid medications both in an out of the hospital. In this research proposal, we will focus on gathering data from several statewide databases including those available through the partnership between the Michigan Surgical Quality Collaborative (MSQC) as well as Blue Cross Blue Shield of Michigan (BCBSM) to investigate the magnitude of new persistent opioid use development among patients having complex surgery. In addition, we will define the role that post-operative opioid exposure plays in development of new persistent opioid use and what patient level factors are predictive of new opioid dependency in this high-risk group of patients. Finally, we will utilize these findings to develop, implement and assess an evidence-based pain plan for patients undergoing complex surgical procedures.