P137. HIGH-RISK OPIOID PRESCRIBING AND PERSISTENT OPIOID USE AFTER MAJOR LOWER LIMB AMPUTATION AMONG MEDICARE BENEFICIARIES

Abstract

PURPOSE: Recently, quality improvement efforts have focused on mitigating opioid related harms among postamputation patients. However, the prevalence of high-risk opioid prescribing practices is not well described, nor the risk factors associated with persistent opioid use among major lower limb amputation patients. METHODS: We reviewed 2009-2018 Medicare claims of major lower limb amputation patients. Prolonged opioid use was defined as one opioid prescription filled within 90-days after discharge and another within 90-180 days. High-risk opioid prescribing included overlapping opioid prescriptions, overlapping benzodiazepine-opioid prescriptions, high daily-doses>100 OMEs, multiple prescribers, and new long-acting opioid use within 90-days postoperatively. We used the Cochran-Armitage-Trend-Test to determine trends in high-risk prescribing over time, and multilevel mixed-effects logistic regression to determine predictors of prolonged use. RESULTS: In total, 5,191 patients were included (Chronic opioid-users=1,432; Intermittent opioid-users=2,195; Opioid-Naïve=1,564). Rates of high-risk prescribing did not change significantly during the study period, and 82.3% chronic (p=0.65), 37.2% non-chronic (p=0.08), and 15.5% opioid-naïve (p=0.74) users were exposed to high-risk prescribing. Individuals with prior opioid fills were more likely to have prolonged use (chronic users OR=2.21, p=0.033; non-chronic users OR=4.46, p<0.001). Among non-chronic users, age<55 years (OR=1.41, p=0.04), concurrent gabapentinoid fills (OR=1.92, p<0.001), and sedative/anxiolytic fills (OR=1.75, p<0.001) were associated with prolonged use. CONCLUSION: Among major lower extremity amputation patients high-risk prescribing practices are common, and have not changed over time. Interventions that focus on tailoring postoperative pain management to preoperative risk factors, including preoperative opioid exposure, will be of high-value to optimize postamputation pain and encourage safe opioid stewardship.