The Association of Cognitive Status and Post-Operative Opioid Prescribing in Older Adults
Objective:. To examine the differences in opioid prescribing by cognitive status following common elective surgical procedures among Medicare beneficiaries. Background:. Older individuals commonly experience changes in cognition with age. Although opioid prescribing is common after surgery, differen...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer Health
2023-09-01
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| Series: | Annals of Surgery Open |
| Online Access: | http://journals.lww.com/10.1097/AS9.0000000000000320 |
| _version_ | 1827780719479357440 |
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| author | Christina L. Shabet, BSE Mark C. Bicket, MD Emilie Blair, BA Hsou Mei Hu, MBA, MHS, PhD Kenneth M. Langa, MD, PhD Mohammed U. Kabeto, MS Deborah A. Levine, MD, MPH Jennifer Waljee, MD, MPH, MS |
| author_facet | Christina L. Shabet, BSE Mark C. Bicket, MD Emilie Blair, BA Hsou Mei Hu, MBA, MHS, PhD Kenneth M. Langa, MD, PhD Mohammed U. Kabeto, MS Deborah A. Levine, MD, MPH Jennifer Waljee, MD, MPH, MS |
| author_sort | Christina L. Shabet, BSE |
| collection | DOAJ |
| description | Objective:. To examine the differences in opioid prescribing by cognitive status following common elective surgical procedures among Medicare beneficiaries.
Background:. Older individuals commonly experience changes in cognition with age. Although opioid prescribing is common after surgery, differences in opioid prescribing after surgery by cognitive status are poorly understood.
Methods:. We conducted a retrospective analysis of patients ≥65 years participating in the Health and Retirement Study (HRS) linked with Medicare claims data who underwent surgeries between January 2007 and November 2016 and had cognitive assessments before the index operation. Cognitive status was defined as normal cognition, mild cognitive impairment (MCI), or dementia. Outcomes assessed were initial perioperative opioid fill rates, refill rates, and high-risk prescriptions fill rates. The total amount of opioids filled during the 30-day postdischarge period was also assessed. Adjusted rates were estimated for patient factors using the Cochran-Armitage test for trend.
Results:. Among the 1874 patients included in the analysis, 68% had normal cognition, 21.3% had MCI, and 10.7% had dementia. Patients with normal cognition (58.1%) and MCI (54.5%) had higher initial preoperative fill rates than patients with dementia (33.5%) (P < 0.001). Overall, patients with dementia had similar opioid refill rates (21%) to patients with normal cognition (24.1%) and MCI (26.5%) (P = 0.322). Although prior opioid exposure did not differ by cognitive status (P = 0.171), among patients with high chronic preoperative use, those with dementia had lower adjusted prescription sizes filled within 30 days following discharge (281 OME) than patients with normal cognition (2147 OME) and MCI (774 OME) (P < 0.001; P = 0.009 respectively). Among opioid-naive patients, patients with dementia also filled smaller prescription sizes (97 OME) compared to patients with normal cognition (205 OME) and patients with MCI (173 OME) (P < 0.001 and P = 0.019, respectively).
Conclusions:. Patients with dementia are less likely to receive postoperative prescriptions, less likely to refill prescriptions, and receive prescriptions of smaller sizes compared to patients with normal cognition or MCI. A cognitive assessment is an additional tool surgeons can use to determine a patient’s individualized postoperative pain control plan. |
| first_indexed | 2024-03-11T15:09:03Z |
| format | Article |
| id | doaj.art-9bc222de0a684c7dad9639272bf61b9a |
| institution | Directory Open Access Journal |
| issn | 2691-3593 |
| language | English |
| last_indexed | 2024-03-11T15:09:03Z |
| publishDate | 2023-09-01 |
| publisher | Wolters Kluwer Health |
| record_format | Article |
| series | Annals of Surgery Open |
| spelling | doaj.art-9bc222de0a684c7dad9639272bf61b9a2023-10-30T03:37:09ZengWolters Kluwer HealthAnnals of Surgery Open2691-35932023-09-0143e32010.1097/AS9.0000000000000320202309000-00025The Association of Cognitive Status and Post-Operative Opioid Prescribing in Older AdultsChristina L. Shabet, BSE0Mark C. Bicket, MD1Emilie Blair, BA2Hsou Mei Hu, MBA, MHS, PhD3Kenneth M. Langa, MD, PhD4Mohammed U. Kabeto, MS5Deborah A. Levine, MD, MPH6Jennifer Waljee, MD, MPH, MS7From the * Department of Surgery, University of Michigan Medical School, University of Michigan, Ann Arbor† Department of Anesthesiology, University of Michigan, Ann Arbor§ Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan, Ann Arbor‡ Michigan Opioid Prescribing Engagement Network (Michigan OPEN), Institute for Healthcare Policy and Innovation, Ann Arbor‡ Michigan Opioid Prescribing Engagement Network (Michigan OPEN), Institute for Healthcare Policy and Innovation, Ann Arbor¶ Department of Internal Medicine, University of Michigan, Ann Arbor¶ Department of Internal Medicine, University of Michigan, Ann Arbor∥ Department of Surgery, Section of Plastic Surgery, University of Michigan, Ann ArborObjective:. To examine the differences in opioid prescribing by cognitive status following common elective surgical procedures among Medicare beneficiaries. Background:. Older individuals commonly experience changes in cognition with age. Although opioid prescribing is common after surgery, differences in opioid prescribing after surgery by cognitive status are poorly understood. Methods:. We conducted a retrospective analysis of patients ≥65 years participating in the Health and Retirement Study (HRS) linked with Medicare claims data who underwent surgeries between January 2007 and November 2016 and had cognitive assessments before the index operation. Cognitive status was defined as normal cognition, mild cognitive impairment (MCI), or dementia. Outcomes assessed were initial perioperative opioid fill rates, refill rates, and high-risk prescriptions fill rates. The total amount of opioids filled during the 30-day postdischarge period was also assessed. Adjusted rates were estimated for patient factors using the Cochran-Armitage test for trend. Results:. Among the 1874 patients included in the analysis, 68% had normal cognition, 21.3% had MCI, and 10.7% had dementia. Patients with normal cognition (58.1%) and MCI (54.5%) had higher initial preoperative fill rates than patients with dementia (33.5%) (P < 0.001). Overall, patients with dementia had similar opioid refill rates (21%) to patients with normal cognition (24.1%) and MCI (26.5%) (P = 0.322). Although prior opioid exposure did not differ by cognitive status (P = 0.171), among patients with high chronic preoperative use, those with dementia had lower adjusted prescription sizes filled within 30 days following discharge (281 OME) than patients with normal cognition (2147 OME) and MCI (774 OME) (P < 0.001; P = 0.009 respectively). Among opioid-naive patients, patients with dementia also filled smaller prescription sizes (97 OME) compared to patients with normal cognition (205 OME) and patients with MCI (173 OME) (P < 0.001 and P = 0.019, respectively). Conclusions:. Patients with dementia are less likely to receive postoperative prescriptions, less likely to refill prescriptions, and receive prescriptions of smaller sizes compared to patients with normal cognition or MCI. A cognitive assessment is an additional tool surgeons can use to determine a patient’s individualized postoperative pain control plan.http://journals.lww.com/10.1097/AS9.0000000000000320 |
| spellingShingle | Christina L. Shabet, BSE Mark C. Bicket, MD Emilie Blair, BA Hsou Mei Hu, MBA, MHS, PhD Kenneth M. Langa, MD, PhD Mohammed U. Kabeto, MS Deborah A. Levine, MD, MPH Jennifer Waljee, MD, MPH, MS The Association of Cognitive Status and Post-Operative Opioid Prescribing in Older Adults Annals of Surgery Open |
| title | The Association of Cognitive Status and Post-Operative Opioid Prescribing in Older Adults |
| title_full | The Association of Cognitive Status and Post-Operative Opioid Prescribing in Older Adults |
| title_fullStr | The Association of Cognitive Status and Post-Operative Opioid Prescribing in Older Adults |
| title_full_unstemmed | The Association of Cognitive Status and Post-Operative Opioid Prescribing in Older Adults |
| title_short | The Association of Cognitive Status and Post-Operative Opioid Prescribing in Older Adults |
| title_sort | association of cognitive status and post operative opioid prescribing in older adults |
| url | http://journals.lww.com/10.1097/AS9.0000000000000320 |
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