Opioid Dependency After Craniomaxillofacial Trauma Surgery.

OBJECTIVE

The opioid crisis has led to significant morbidity and mortality. A component of this is attributable to overdoses on prescribed opioids. A prior study estimated that 39% of opioid prescriptions after craniomaxillofacial (CMF) trauma were potentially inappropriate prescriptions. The goal of this study was to identify factors associated with potentially inappropriate and prolonged opioid prescriptions in the postoperative CMF trauma patient population.

STUDY

DESIGN

Retrospective cohort.

SETTING

Merative™ MarketScan® Commercial & Multi-State Medicaid Databases (2015-2022).

METHODS

Patients undergoing CMF trauma surgery were identified and stratified based on whether they had commercial versus Medicaid insurance. The association of prolonged opioid prescription length with demographic, comorbid, and surgical factors was investigated.

RESULTS

A total of 23,985 patients from 2015 to 2022 underwent CMF trauma surgery and received postoperative opioid prescriptions. The average prescription length was significantly lower in the commercially insured cohort versus the Medicaid cohort (24.6 days vs 33.7 days), and 22% of prescriptions were potentially inappropriate in nature. A diagnosis of chronic pain, as well as having 2 overlapping opioid prescriptions or an extended-release opioid prescription, had the highest adjusted odds of a prescription longer than 30 days.

CONCLUSION

Although potentially inappropriate prescriptions after CMF trauma surgery decreased from a prior estimate (39% vs 22%), inappropriate prescribing practices are highly associated with prolonged opioid prescriptions. Providers must ensure patients do not have an existing opioid prescription before writing an additional one and should not dispense extended-release formulations in the acute postoperative setting.