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Original Investigation
September 19, 2019

Association of Opioids With Incisional Ocular Surgery

Author Affiliations
  • 1Scheie Eye Institute, Perelman School of Medicine, Department of Ophthalmology, University of Pennsylvania, Philadelphia
  • 2Center for Preventive Ophthalmology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
  • 3Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
  • 4Leonard Davis Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia
JAMA Ophthalmol. 2019;137(11):1283-1291. doi:10.1001/jamaophthalmol.2019.3694
Key Points

Question  What is the rate of filled opioid prescriptions around the time of incisional ocular surgeries, and how has that rate changed with time?

Findings  In this cohort study querying a large national US insurer’s claims database, we found an increasing trend of filled opioid prescriptions over the course of all years studied (2000-2016). Race/ethnicity, education, yearly income, and geographic location affected the rate of filled opioid prescriptions.

Meaning  Further research may be warranted to study the trend of increasing rates of filled perioperative opioid prescriptions identified in this investigation.

Abstract

Importance  Opioid abuse has been declared a public health emergency. Currently, little is known about the association between opioids and ocular surgery.

Objective  To characterize rates of filled opioid prescriptions after incisional ocular surgeries.

Design, Setting, and Participants  This cohort study included patients with incisional ocular surgeries within a large national US insurer’s administrative medical claims database. All incisional ocular surgeries from January 2000 through December 2016 were evaluated. An opioid prescription was eligible if it occurred from 1 day before to 7 days after a surgery. Any surgery on a patient who was younger than 18 years, had more than 30 consecutive days of an opioid prescription in the prior 6 months, or had less than 6 months of data in the database prior to surgery was excluded. Data analysis occurred from May 2018 through November 2018.

Main Outcomes and Measures  The rate of opioid prescriptions filled for all incisional ocular surgeries from 2000 through 2016. Primary analysis looked at the rate of filled opioid prescriptions for each ophthalmic subspecialty surgery over time. Secondary analysis assessed which patient or surgical characteristics (ie, age, sex, race/ethnicity, geographic locations, yearly income, educational level, and type of eye surgery) were associated with filling an opioid prescription. Multivariate logistic regression using generalized estimating equations was used to determine odds ratios (ORs) of filling an opioid prescription.

Results  A total of 2 407 962 incisional ocular surgeries were included, of which 45 776 (1.90%) were associated with an opioid prescription. The rate of filled opioid prescriptions varied considerably over time, with the lowest rate occurring in the 2000-2001 cohort year (671 of 45 776 [1.24%]) and the highest in 2014 (5559 of 45 776 [2.51%]). An increasing trend was seen over the course of the study (2000-2001: 671 of 45 776 [1.24%]; 2016: 5851 of 45 776 [2.07%]; P < .001). Multivariate logistic regression showed that year of surgery was significantly associated with filling an opioid prescription, with the highest odds in 2014 (OR, 3.71 [95% CI, 3.33-4.1]), 2015 (OR, 3.33 [95% CI, 2.99-3.70]), and 2016 (OR, 3.27 [95% CI, 2.94-3.63]) compared with 2000 to 2001 (P < .001).

Conclusions and Relevance  These findings suggest the rate of filled opioid prescriptions are increasing for all types of incisional ocular surgery over time. Given the ongoing national opioid epidemic, understanding patterns of use can help in reversing the epidemic.

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