INCIDENCE AND RISK FACTORS OF CHRONIC OPIOID USE AFTER SLEEP APNEA SURGERY

Study Objectives: To assess the incidence and risk factors of chronic opioid use after obstructive sleep apnea surgery. Methods: Using IBM MarketScan research database, adults (>18 years) who underwent a variety of sleep surgery procedures between 2007 and 2015 were identified. Individuals with 1 year of insurance coverage before and after the surgical procedure were included. Additional anesthesia event(s) in the year following the procedure of interest and those who filled an opioid prescription within the year prior to surgery (not naive) were excluded. Outcomes included rates of persistent opioid use (additional opioid prescriptions filled 90-180 days postoperatively), prolonged use (additional opioid prescriptions filled 181-365 days postoperatively), and inappropriate use (> 100 morphine milligram equivalents). Evaluated variables include demographics, surgical procedures, and comorbidities. Results: A total of 10,766 surgical procedures met the inclusion criteria. There was a trend of increased rates of perioperative opioid prescription. After multivariable logistic regression analysis, perioperative opioid prescription and smoking were independent risk factors for inappropriate opioid use (odds ratio [OR] = 31.51, P <.001; OR = 1.41, P =.016, respectively). Opioid prescription and hypertension were independent risk factors for persistent opioid use (OR = 37.8, P <.001, OR = 1.38, P =.008). Perioperative opioid prescription, previous opioid dependence diagnosis, smoking, and male sex were associated with continuous prolonged opioid use (OR = 73.1, 8.13, 1.95, and 1.55, respectively; P <.001, P =.020, P =.024, and P =.032, respectively). Conclusions: While efforts by different societies are being implemented to control the opioid crisis, we found that perioperative opioid prescription for airway surgery targeting obstructive sleep apnea is an independent risk factor for persistent, prolonged, and inappropriate opioid use.