08: Prevalence of new persistent opioid use among opioid naive women undergoing hysterectomy

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(1) Determine a data-driven definition of new persistent opioid use among opioid naïve women undergoing hysterectomy and (2) to determine the prevalence of and risk factors for new persistent opioid use. We used data from OPTUM, a national database that includes both medical and pharmacy data for over 73 million individuals from a single private health insurer. Hysterectomies performed from January 1, 2011, to December 31, 2014, were identified using Current Procedural Terminology (CPT), International Classification of Diseases (ICD)-9 and ICD-10 codes. Inclusion criteria included: age ≤63 years at hysterectomy and no opioid fills for 8 months preceding, excluding the 30 days immediately prior. Anesthesia CPT codes were used to identify cases with additional procedures in the 12 months following the hysterectomy and these cases were excluded. Number of opioid prescription fills, days supplied, and total oral morphine equivalents (OMEs) were analyzed to determine the distribution of opioid us. The perioperative period was defined as 30 days prior to 14 days post hysterectomy. “Persistent” opioid use was defined as: ≥2 opioid fills within 6 months of hysterectomy with at least one fill per 3 months, excluding the perioperative period, and either total OME ≥1,650 or days supplied ≥48. Demographics including age, race, educational level, and region of country were obtained, and ICD-9 and ICD-10 diagnosis codes were used to identify hysterectomy indications, chronic pain disorders, depression/anxiety, and substance abuse. Bivariate analyses were used to compare persistent to non-persistent opioid users. Hierarchical mixed modeling controlling for region of country was used to determine factors associated with new persistent opioid use following hysterectomy. Of the 28,279 women included for analyses, the prevalence of new persistent opioid use was 0.8% (N = 224). Overall, 85.77% (N = 24,256) had no additional opioid fills after the perioperative period. Average perioperative OMEs for persistent users was 481.4 ± 862.3 compared to 35.3 ± 167.1 for non-persistent users. Results of bivariate comparisons between new persistent and non-persistent opioid users are shown in Table 1. Using mixed hierarchical modeling, factors identified as independently associated with new persistent opioid use included: increasing age (aOR = 1.04, 95% CI = 1.02-1.06, p < 0.0001), black race (ref: white, aOR = 2.31, 95% CI = 1.66-3.22, p < 0.0001), education <12thgrade (ref: ≥bachelor’s degree, aOR = 5.93, 95% CI = 1.78-19.74, p = 0.004), depression/anxiety (aOR = 2.18, 95% CI = 1.57-3.04, p < 0.0001), gynecologic cancer (aOR = 3.72, 95% CI = 2.81-4.93, p < 0.0001), preoperative opioid fill within 30 days of surgery (aOR = 4.15, 95% CI = 3.15-5.47, p < 0.0001) and non-vaginal routes (abdominal: aOR = 5.21, 95% CI = 3.15-8.64, p < 0.0001, laparoscopic: aOR = 1.76, 95% CI = 1.04-2.99, p = 0.04, LAVH: aOR = 2.28, 95% CI = 1.09-4.78, p = 0.03). C-statistic for this model is 0.83. Based on our definition, the prevalence of new persistent opioid use among opioid naïve women undergoing hysterectomy is low; however, two potentially modifiable risk factors are providing an opioid prescription preoperatively and performing non-vaginal hysterectomy.