Fewer Opioids Used Over More Time Linked to Lower Costs, Better Outcomes

    Providing fewer total opioids over a longer period of time is associated with lower overall costs and utilization for hip surgery patients, according to a new study by researchers from the Duke Clinical Research Institute (DCRI).

    With opioid overdoses and abuse a subject of growing concern for public health agencies, the Centers for Disease Control issued a series of guidelines in 2016 intended to improve communication between clinicians and patients about the risks and benefits of opioid drug therapy.

    Although these guidelines included recommendations for acute, general surgery opioid management, there has been little research into management strategies for intermediate- to long-term post-surgical musculoskeletal pain.

    Analyzing Opioid Prescription Strategies

    In an observational cohort study, the DCRI’s Chad Cook, PhD, and his colleagues sought to analyze postoperative opioid prescription strategies and measure direct and indirect healthcare utilization and costs in individuals undergoing non-arthroplasty orthopedic hip surgery.

    The study was published in the journal Substance Abuse Treatment, Prevention, and Policy.

    Using data from the Military Health System Data Repository (MDR), which serves as the centralized data repository for all Defense Health Agency corporate health care data, the researchers identified 1219 patients who underwent hip surgery between 2003 and 2015.The dataset included information on opioid management for 12 months before and 24 months after surgery.

    Using cluster analysis, Dr. Cook and his study team then identified 2 distinct postoperative opioid prescription subgroups:

    • Patients who received a high total number of opioids over a short period of time (n=850)
    • Patients who received fewer total opioids over a longer period of time (n=369)

    The researchers then used linear mixed effects modeling to examine opioid prescription pattern subgroups and identify subgroup differences in healthcare utilization and costs.

    Findings Are Counter to Study Hypothesis

    Overall, patients in the subgroup that were prescribed more opioids over a shorter duration had more preoperative comorbidities, opioid prescriptions, and total days of opioid pain medications. This subgroup was also younger and had a higher proportion of heavy preoperative healthcare utilization.

    Noting that this finding ran counter to their hypothesis, the researchers posited 4 possibilities for this outcome:

    • The findings are reflective of pre-operative co-morbid conditions
    • The subgroup receiving more opioids over a shorter amount of time was associated with the preoperative opioid use patterns of its patients
    • The subgroup receiving fewer opioids over a longer amount of time benefited more from opioids by receiving adequate pain management
    • Higher costs and utilization are associated with increased incidences of side effects in the subgroup receiving more opioids over a longer amount of time

    These findings, Dr. Cook said, illustrate the need for randomized trials to better understand the effectiveness of opioid prescription patterns on reducing side effects and minimizing the chances of opioid abuse.

    “We need to start looking at patterns of treatment,” he said. “We couldn’t find anything in the literature about other musculoskeletal conditions or postsurgical conditions. This topic is essentially unstudied.”


    Cook CE. Rhon DI, Lewis BD, George SZ. Post-operative opioid pain management patterns for patients who receive hip surgery. Substance Abuse Treatment, Prevention, and Policy.2017;12:14. doi: 10.1186/s13011-017-0094-5.