Opioid consumption after lower limb amputation in Medicare beneficiaries

Alexander N Khouri; Nishant Ganesh Kumar; Hsou-Mei Hu; Maryam Yazdanfar; Jennifer F Waljee; Theodore A Kung

doi:10.1002/pmrj.13408

Opioid consumption after lower limb amputation in Medicare beneficiaries

PM R. 2025 Jun 16. doi: 10.1002/pmrj.13408. Online ahead of print.

Authors

Alexander N Khouri¹, Nishant Ganesh Kumar¹, Hsou-Mei Hu², Maryam Yazdanfar², Jennifer F Waljee^{1

2}, Theodore A Kung¹

Affiliations

¹ Department of Surgery, Section of Plastic Surgery, University of Michigan, Ann Arbor, Michigan, USA.
² The Overdose Prevention Engagement Network (OPEN), University of Michigan Health System, Ann Arbor, Michigan, USA.

PMID: 40522186
DOI: 10.1002/pmrj.13408

Abstract

Background: Despite targeted national quality improvement initiatives, opioid prescription and use patterns after lower limb amputation are not well studied.

Objective: To determine risk factors associated with extended opioid use and rates of high-risk opioid prescribing after lower limb amputation.

Design and setting: A retrospective population-based study was performed by querying a 20% national sample of Medicare claims of patients undergoing lower limb amputation from 2009 to 2018. Patients were excluded if they did not discharge home or had subsequent surgery 180 days after discharge. Extended opioid use was defined as one opioid prescription filled within 90 days after discharge and another within 90-180 days. Chronic opioid users were defined as having a 180-day supply over the preoperative surgical period and at least one opioid prescription within 60 days of surgery. High-risk opioid prescribing included overlapping opioid prescriptions, overlapping benzodiazepine-opioid prescriptions, high daily doses >100 oral morphine milligram equivalents, multiple prescribers, and new long-acting opioid use within 90 days postoperatively. Multilevel mixed-effects logistic regression and the Cochran-Armitage Trend Test was used.

Main outcome: New persistent and prolonged opioid use following lower extremity amputation.

Results: The study included 5191 patients included (nonchronic opioid users = 3759, chronic opioid users = 1432). Among the nonchronic opioid users, 873 (23.2%) had new persistent opioid use after surgery. In these patients, age < 55 years (odds ratio [OR], 1.41, p = .04), concurrent gabapentinoid fills (OR, 1.92, p < .001), and sedative/anxiolytic fills (OR, 1.75, p < .001) were associated with new persistent use. Of the chronic opioid users, 1306 (91.2%) had prolonged opioid use after surgery. Rates of high-risk prescribing did not change significantly during the study period, and 82.3% of chronic opioid users were exposed to high-risk prescribing.

Conclusions: Extended opioid use is common following lower extremity amputation. Moreover, high-risk prescribing practices remain common and have not changed over time.