Lippincott Williams & Wilkins



Supplemental Table 3. Study and population characteristicsSurgical populationsFirst Author YearCountryStudy designSurgical population Medico-administrative databaseSample size Age Females (N (%))Pre-surgical opioid prescription statusAdditional inclusion/exclusion criteriaπAcute post-operative opioid prescription statusFollow-up (months)?OutcomeProlonged opioid prescription Long-term opioid prescriptionAnthony242017USAR-MAOrthoHumana4946n/an/an, mnoneContinuous prescriptions since event12√√Bedard252018USAR-MAArthroHumana4205AE2283 (54.3)n, mnoneContinuous prescriptions since event12√√Bedard262017USAR-MAArthroHumana37 393AE15?349 (41.0)n, mnoneContinuous prescriptions since event12√√Bedard272017USAR-MAArthro Humana73 959AE 47?180 (63.8)n, mnoneContinuous prescriptions since event12√√Brummett282017USAR-MAMixedClinformatics Data Mart36 177A23?913 (66.1)nnonePeri-operative prescription as inclusion criteria3-6√-Clarke29 **2014CAR-MAMixedCIHI / OHIP /Registered Persons Database /Ontario Drug Benefit Database39 140E18?753 (47.9)n≠ palliative careAcute postoperative opioid prescription required in criteria for prolonged opioid therapy6√-Soneji47 **,?201612√√Connolly30 2017USAR-MAOrthoClinformatics Data Mart8377A4702 (56.1)n,p,m≠ cancer, fracture, infection, spine inflammation, hx trauma; ≠ pregnancy; insuranceUnknown24-√First Author YearCountryStudy designSurgical population Medico-administrative databaseSample size Age Females (N (%))Pre-surgical opioid statusAdditional inclusion/exclusion criteriaπAcute post-operative opioid statusFollow-up (months)?OutcomeProlonged opioid prescription Long-term opioid prescriptionDeyo18 ? 2018USAR-MAOrthoOregon’s prescription drug monitoring program2491AE1486 (59.7)n,p,m≠ fracture or inflammatory spondylopathy, ≠ cancer or spinal infectionUnknown7 -√Hadland-smyth32?2018USAR-MAArthroVeterans’ Affairs datasets through VA Informatics and Computing Infrastructure6195AE--n,p,mnoneContinuous prescriptions since event12 -√Hansen332017AUR-MAArthroAustralian Government Department of Veterans’ Affairs’ administrative database13,584 (15,020 cx)AE7442 (49.5)n,p,m≠ cancer Continuous prescriptions since event> 6 -√Inacio352016AUR-MAArthroAustralian Government Department of Veterans’ Affairs’ administrative database8925 (9525 cx)E4891 (51.3)n,p,m≠ cancerContinuous prescriptions since event3-6 √-Johnson362016USAR-MAPlasticMarketScan (Truven Health Analytics)77 573 AE46 893 (60.5)n≠ dx opioid dependence or abuse; isolated injuries Peri-operative prescription as inclusion criteria6 √-Kim382017USAR-MAArthroClinformatics Data Mart57 545AE32?801 (57.0)n,p,m≠ cancer; no sx for fracture; no arthroplasty past 12mPeri-operative prescription as inclusion criteria12 -√Kim372018USARArthron/a54AE31 (57.4)pnoneUnknown6 √-First Author YearCountryStudy designSurgical population Medico-administrative databaseSample size Age Females (N (%))Pre-surgical opioid statusAdditional inclusion/exclusion criteriaπAcute post-operative opioid statusFollow-up (months)?OutcomeProlonged opioid prescription Long-term opioid prescriptionLawrence392008USAPOrthon/a91AE--p, mNo neck pain greater than radicular painContinuous prescriptions since event3-24 -√Mohanty402017USATCBariatricMichigan Bariatric Surgery Collaborative14 063----n, mnoneUnknown12 -√Mosher41 2018USAR-MAMixedAustin Information Technology Center26 476AE1807 (6.8)n≠ metastatic cancer, palliative care or opioid-dependence txPeri-operative prescription as inclusion criteria> 3 √-Moyer422011USAPPlasticn/a6A3 (50.0)pHyperalgesic/painful burn scars Acute postoperative opioid prescription required in criteria for long-term opioid prescription13.0±4.3 -√Mueller43 2017USAR-MAArthroMarketScan (Truven Health Analytics)6695A2856 (42.7)n, p, m≠ cancerAcute postoperative opioid prescription required in criteria for long-term opioid prescription12 √Politzer44 2017USAR-MAArthroHumana66 950AE42?458 (63.4)n, mnoneContinuous prescriptions since event> 6 -√Qureshi45 2018USAR-MANeuro-surgical PearlDiver Database1321A625 (47.3)P≠ concomitant spine fusion, spinal infections, cancer, traumaContinuous prescriptions since event> 3 √-Rios46 1998USARDigest.Medical University of South Carolina17A11 (64.7)PChronic pancreatitis; duct ≤ 7mm diameter; ≠ prior ductal or resectional surgeryAcute postoperative opioid prescription required in criteria for prolonged opioid therapy10.3 (3-16)-√First Author YearCountryStudy designSurgical population Medico-administrative databaseSample size Age Females (N (%))Pre-surgical opioid statusAdditional inclusion/exclusion criteriaπAcute post-operative opioid prescription statusFollow-up (months)?OutcomeProlonged opioid prescription Long-term opioid prescriptionRozet10 2014USARArthroVeteran’s Administration Puget Sound Health Care System145A18 (12.4)n, m≠ arthro on contralateral leg or anterior/posterior cruciate ligament repair; ≠ procedure < 6m before indexed sxAcute postoperative opioid prescription required in criteria for prolonged opioid therapy3.5 √-Schoenfeld11 2017USAR-MAOrthoTRICARE insurance claims from the Military Health System Data Repository9991A3694 (37.0)n≠ cancer or trauma; ≠ eligible for Medicare or MedicaidContinuous prescriptions since event12 √√Sun48 ?2016USAR-MAMixedMarketScan (Truven Health Analytics)641 941A472?276 (73.6)n3yr enrollment insurance planUnknown12 -√Westermann50 2017USAR-MAOrthoHumana35 155AE16?523 (47.0)n,pnoneUnknown12 √√Yang51 2015USARDigest.Beth Israel Deaconess Medical Center66AE 34 (51.5)n,pDiagnosis of recurrent acute or chronic pancreatitisUnknown36 -√Zarling52 2016USARArthroMichigan Automated Prescription System database315AE208 (66.0)p, mnoneOpioid prescription examined by periods of 6 weeks postoperatively12 -√Trauma populationsFirst AuthorYearCountryStudy designTrauma type Medico-administrative databaseSample size Age Females (N(%))Pre-trauma opioid prescription statusInclusion criteriaπAcute post-operative opioid prescription statusFollow-up (months)?OutcomeProlonged opioid prescription Long-term opioid prescriptionAl Dabbagh23 2014SWER-MAMixedSwedish National Hospital Discharge Register/National Pharmacy Register/Total Population Register639AE250 (39.1)nNo associated fracturePeri-operative prescription as inclusion criteria17 (7-27)√√Al Dabbagh3? 2016SWER-MAMixedSwedish National Hospital Discharge Register/Swedish Prescribed Drug Register891AE501 (56.2)nNo associated skeletal injuriesPeri-operative prescription as inclusion criteria20 (11-32)√√Daoust31 2017CAR-MAMixedQuebec Trauma Registry/Medical Consultations and Medications Database39 833E27?564 (69.2)n,p,mnoneLong-term opioid prescription associated with initial injury12 -√Holman34 2013USAR-MAOrthoUtah Controlled Substance Database613AE--n,p,m≠ multisystem or multiple-limb traumaContinuous prescriptions since event > 3√-Weiss49 2012SWER-MAFracture Swedish National Hospital Discharge Registry/National Pharmacy Register1017AE--n≠ fracturePeri-operative prescription as inclusion criteria14 (5-24)√√Zwisler53 2015DENRMixedOdense University Hospital trauma database938AE284 (30.3)n, mnoneUnknown> 6 -√** Same patient cohort; ? Follow-up time recorded in this table refers to the last time points at which data was collected. Median (range) is used for studies with varying time points across patients. ?Based on correspondence with the author. R: longitudinal retrospective study design. P: longitudinal prospective study design. R-MA= longitudinal retrospective study design using medico-administrative databases only. TC: transversal/cross-sectional study. Arthro: Arthroplasty (knee, hip or shoulder). SWE: Sweden, DEN: Denmark, CA: Canada. A: Adults (18-65 years old). AE: Adults and elderly (> 18 years old). p = patients with pre-event prolonged opioid prescription; n = patients with no/short-term opioid prescription pre-event; m = pre-event mixed patient group (unable to determine opioid status); hx: history; dx: diagnosis; sx: symptoms; tx: treatments. CIHI: Canadian Institute for Health Information. OHIP: Ontario Health Insurance Plan. 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ADDIN EN.CITE.DATA 51 the former is reporting on the 6-month outcomes, while the latter is reporting on > 6-month outcomes, and therefore both were eligible for inclusion. The Clarke and Soneji studies also had 26% of their patients who underwent cancer-related surgeries. However, the authors directly stated that they selected their surgical procedures as to minimize the presence of preoperative chronic pain problems (which would then reduce the risk factor of cancer-related chronic analgesia that motivated the use of this exclusion criteria to start with). As such these article were retained.Supplemental Table 6. Results of individual risk factors for opioid prescription 3-6 months and >6 months post-surgery or trauma among individuals with no/short-term opioid prescription pre-eventRisk factor categoryRisk factorStudiesData source for risk factorPeriod considered preop/ pretraumaNOut-come Type of effect sizeEffect size (95% CI)SociodemographicFemale sex (ref: male sex)Brummett (2017)----36,177Rx_3-6OR0.99 (0.90, 1.10)Female sex (ref: male sex)Clarke (2014)----39,140Rx_3-6OR1.10 (0.96, 1.27)Female sex (ref: male sex)Johnson (2016)----59,725Rx_3-6OR1.1 (1.0, 1.2)Female sex (ref: male sex)Mosher (2018)----26,476Rx_3-6OR0.73 (0.63, 0.86)Female sex (ref: male sex)Holman (2013)----613Rx_3-6RR1.06 (0.79, 1.43)Female sex (ref: male sex)Al Dabbagh (2014)----639Rx_>6HR1.1 (0.9, 1.4)Female sex (ref: male sex)Al Dabbagh (2016)----891Rx_>6HR1.2 (1.0, 1.4)Female sex (ref: male sex)Schoenfeld (2017)----9991Rx_>6HR0.99 (0.93, 1.07)Female sex (ref: male sex)Daoust (2017) ----39,833Rx_>6OR1.27 (1.16, 1.38)Female sex (ref: male sex)Sun (2016)----641,941Rx_>6OR1.34 (-, -)Age (5yr increment)Holman (2013)----613Rx_3-6RR1.06 (1.02, 1.11)Age: 66-75 (ref: age 86+)Clarke (2014)----39,140Rx_3-6OR1.63 (1.08, 2.46)Age: 76-85 (ref: age 86+)Clarke (2014)----39,140Rx_3-6OR1.47 (0.97, 2.22)Age: 18-34 (ref: 50-64)Mosher (2018)----26,476Rx_3-6OR0.72 (0.61, 0.86)Age: 35-49 (ref: 50-64)Mosher (2018)----26,476Rx_3-6OR0.91 (0.81, 1.02)Age: 65-79 (ref: 50-64)Mosher (2018)----26,476Rx_3-6OR0.59 (0.54, 0.65)Age: 80+ (ref: 50-64)Mosher (2018)----26,476Rx_3-6OR0.41 (0.35, 0.49)Age: missing (ref: 50-64)Mosher (2018)----26,476Rx_3-6OR0.49 (0.31, 0.79)Age: 35-44 (ref: age 18-34)Johnson (2016)----59,725Rx_3-6OR1 (0.9, 1.2)Age: 45-54 (ref: age 18-34)Johnson (2016)----59,725Rx_3-6OR1 (0.9, 1.1)Age: 55-64 (ref: age 18-34)Johnson (2016)----59,725Rx_3-6OR0.9 (0.8, 1)Age: 65+ (ref: age 18-34)Johnson (2016)----59,725Rx_3-6OR0.8 (0.7, 0.9)Age: 30-39 (ref: age 18-29)Brummett (2017)----36,177Rx_3-6OR0.76 (0.64, 0.9)Age: 40-49 (ref: age 18-29)Brummett (2017)----36,177Rx_3-6OR0.72 (0.61, 0.84)Age: 50-59 (ref: age 18-29)Brummett (2017)----36,177Rx_3-6OR0.88 (0.75, 1.04)Age: 60-64 (ref: age 18-29)Brummett (2017)----36,177Rx_3-6OR0.9 (0.74, 1.1)Age: 50+ (ref: age <50)Sun (2016)----641,941Rx_>6OR1.74 (1.45, 2.09)Age: older age (ref: younger age)Al Dabbagh (2014)----639Rx_>6HR1.5 (1.3, 1.9)Age: older age (ref: younger age)Al Dabbagh (2016)----891Rx_>6HR1.9 (1.5, 2.3)Age: older age (ref: younger age)Weiss (2012)----396Rx_>6HR2.0 (1.5, 2.7)Race - Black (ref: White)Mosher (2018)----26,476Rx_3-6OR0.96 (0.83, 1.13)Race – Other/unknown (ref: White)Mosher (2018)----26,476Rx_3-6OR0.78 (0.66, 0.92)Race - African American (ref: White)Brummett (2017)----36,177Rx_3-6OR1.13 (0.97, 1.3)Race - Asian (ref: White)Brummett (2017)----36,177Rx_3-6OR0.73 (0.51, 1.04)Race - Hispanic (ref: White)Brummett (2017)----36,177Rx_3-6OR0.98 (0.84, 1.15)Rural region (ref: urban)Clarke (2014)----39,140Rx_3-6OR0.98 (0.83, 1.15)Isolated region (ref: urban)Mosher (2018)----26,476Rx_3-6OR1.02 (0.92, 1.14)Small rural region (ref: urban)Mosher (2018)----26,476Rx_3-6OR1.29 (1.14, 1.47)Large rural region (ref: urban)Mosher (2018)----26,476Rx_3-6OR1.02 (0.9, 1.17)Married (ref: other civil status)Schoenfeld (2017)----9,991Rx_>6HR0.96 (0.91, 1.03)Military rank - Junior enlisted (ref: Rank – officer)Schoenfeld (2017)----9,991Rx_>6HR0.8 (0.72, 0.9)Military rank - other (ref: Rank – officer)Schoenfeld (2017)----9,991Rx_>6HR1.07 (0.95, 1.19)Military rank - Senior enlisted (ref: Rank – officer)Schoenfeld (2017)----9,991Rx_>6HR0.94 (0.89, 0.99)Education – High school (ref: college or more)Brummett (2017)----36,177Rx_3-6OR1.22 (1.04, 1.43)Education – < High school (ref: college or more)Brummett (2017)----36,177Rx_3-6OR1.08 (0.53, 2.18)Education – Some college (ref: college or more)Brummett (2017)----36,177Rx_3-6OR1.19 (1.03, 1.38)Neighborhood income (fifth) – 2nd lowest (ref: lowest)Clarke (2014)----39,140Rx_3-6OR0.98 (0.82, 1.16)Neighborhood income (fifth) – 3rd lowest (ref: lowest)Clarke (2014)----39,140Rx_3-6OR0.9 (0.75, 1.07)Neighborhood income (fifth) – 2nd highest (ref: lowest)Clarke (2014)----39,140Rx_3-6OR0.76 (0.63, 0.92)Neighborhood income (fifth) – highest (ref: lowest)Clarke (2014)----39,140Rx_3-6OR0.77 (0.64, 0.93)Median household income $40,000-$49,000 (ref: < $40,000)Johnson (2016)----59,725Rx_3-6OR1 (0.9, 1.2)Median household income $50,000-$59,000 (ref: < $40,000)Johnson (2016)----59,725Rx_3-6OR1 (0.8, 1.2)Median household income $60,000-$69,000 (ref: < $40,000)Johnson (2016)----59,725Rx_3-6OR0.8 (0.7, 0.9)Median household income $70,000+ (ref: < $40,000)Johnson (2016)----59,725Rx_3-6OR0.7 (0.6, 0.9)Insurance plan –comprehensive (ref: preferred provider organization)Johnson (2016)----59,725Rx_3-6OR1.1 (1, 1.3)Insurance plan –health maintenance organization (ref: preferred provider organization)Johnson (2016)----59,725Rx_3-6OR1 (0.9, 1.1)Insurance plan –other (ref: preferred provider organization)Johnson (2016)----59,725Rx_3-6OR1 (0.9, 1.1)Insurance plan –point of service (ref: preferred provider organization)Johnson (2016)----59,725Rx_3-6OR1.1 (1, 1.2)Health behaviorsTobacco dependenceBrummett (2017)ICD91 year36,177Rx_3-6OR1.35 (1.21, 1.49)Tobacco dependenceJohnson (2016)ICD91 year59,725Rx_3-6OR1.6 (1.0, 2.6)Alcohol dependenceJohnson (2016)ICD91 year59,725Rx_3-6OR1.3 (0.9, 2)Alcohol or drug dependenceDaoust (2017)ICD91 year39,833Rx_>6OR1.28 (0.94, 1.74)Alcohol dependence Sun (2016)ICD91 year641,941Rx_>6OR1.83 (-, -)Alcohol or drug dependenceBrummett (2017)CCS-AHRQ1 year36,177Rx_3-6OR1.34 (1.05, 1.72)Drug dependenceJohnson (2016)ICD91 year59,725Rx_3-6OR0.9 (0.6, 1.5)Drug dependence Sun (2016)ICD91 year641,941Rx_>6OR3.15 (1.1, 9.05)Pre-event medication useACE inhibitors Clarke (2014)ODBD3 months39,140Rx_3-6OR1.26 (1.09, 1.44)Angiotensin receptor blockersClarke (2014)ODBD3 months39,140Rx_3-6OR1.08 (0.9, 1.28)AntidepressantsMosher (2014)VHA1 year26,476Rx_3-6OR1.26 (1.16, 1.37)Antidepressants (SSRIs)Clarke (2018)ODBD3 months39,140Rx_3-6OR1.41 (1.10, 1.80)Antidepressants Sun (2016)TMSD1 year641,941Rx_>6OR1.65 (1.38, 1.98)Antipsychotics Sun (2016)TMSD1 year641,941Rx_>6OR1.14 (0.88, 1.48)Beta blockers Clarke (2014)ODBD3 months39,140Rx_3-6OR1.05 (0.92, 1.21)BenzodiazepineClarke (2014)ODBD3 months39,140Rx_3-6OR1.26 (1.07, 1.48)Benzodiazepine Sun (2016)TMSD1 year641,941Rx_>6OR1.82 (1.48, 2.24)Benzodiazepine in past year (ref: none in past year)Mosher (2018)VHA1 year26,476Rx_3-6OR0.84 (0.72, 0.98)Benzodiazepine current use (ref: none in past year)Mosher (2018)VHA1 year26,476Rx_3-6OR1.56 (1.41, 1.73)Muscle relaxant in past year (ref: none in the past year)Mosher (2018)VHA1 year26,476Rx_3-6OR1.17 (1.01, 1.35)Muscle relaxant current use (ref: none in past year)Mosher (2018)VHA1 year26,476Rx_3-6OR1.69 (1.52, 1.89)Pre-event long-term opioid use (ref: pre-event opioid na?ve)Holman (2013)UCSB3 months613Rx_3-6RR5.14 (3.84, 6.87)Pre-event short-term opioid use (ref: pre-event opioid na?ve)Holman (2013)UCSB3 months613Rx_3-6RR1.66 (0.7, 3.94)Pre-event short-term opioid use (30 days) (ref: pre-event opioid na?ve) Brummett (2017)MA1 year36,177Rx_3-6OR1.93 (1.71, 2.19)Number pre-event opioid prescription > 1 (ref: 0) Daoust (2017)RAMQ1 year39,833Rx_>6OR11.4 (10.5, 12.5)Number pre-event opioid prescription = 1 (ref: 0) Daoust (2017)RAMQ1 year39,833Rx_>6OR2.26 (2, 2.56)StatinsClarke (2014)ODBD3 months39,140Rx_3-6OR1 (0.88, 1.14)MSK conditionsArthritisBrummett (2017)ICD9 1 year36,177Rx_3-6OR1.56 (1.4, 1.73)Back painBrummett (2017)ICD91 year36,177Rx_3-6OR1.57 (1.42, 1.75)Back diagnosis: deformity (ref: disc degeneration)Schoenfeld (2017)MDR--9,991Rx_>6HR0.73 (0.59, 0.91)Back diagnosis: fracture (ref: disc degeneration)Schoenfeld (2017)MDR--9,991Rx_>6HR0.81 (0.69, 0.95)Back diagnosis: other (ref: disc degeneration)Schoenfeld (2017)MDR--9,991Rx_>6HR1.29 (1.14, 1.45)Back diagnosis: revision (ref: disc degeneration)Schoenfeld (2017)MDR--9,991Rx_>6HR1.09 (0.9, 1.33)Back diagnosis: spondylolisthesis (ref: disc degeneration)Schoenfeld (2017)MDR--9,991Rx_>6HR1.05 (0.92, 1.19)Back diagnosis: stenosis (ref: disc degeneration)Schoenfeld (2017)MDR--9,991Rx_>6HR1.04 (0.98, 1.1)Chronic painMosher (2018)ICD91 year26,476Rx_3-6OR1.18 (1.04, 1.21)Chronic pain historyJohnson (2016)ICD91 year59,725Rx_3-6OR1 (0.9, 1.2)Chronic pain other than reason for surgeryBrummett (2017)ICD91 year36,177Rx_3-6OR1.39 (1.26, 1.54)Psychiatric diagnosesAdjustment disorderBrummett (2017)CCS-AHRQ1 year36,177Rx_3-6OR0.86 (0.68, 1.07)Anxiety disorderBrummett (2017)CCS-AHRQ1 year36,177Rx_3-6OR1.25 (1.10, 1.42)Anxiety disorderMosher (2018)ICD91 year26,476Rx_3-6OR1.07 (0.95, 1.21)Anxiety disorderSchoenfeld (2017)ICD91 year9,991Rx_>6HR0.85 (0.67, 1.06)Anxiety disorderDaoust (2017)ICD91 year39,833Rx_>6OR1.12 (0.99, 1.27)Depressive disorderBrummett (2017)CCS-AHRQ1 year36,177Rx_3-6OR1.15 (1.01, 1.30)Depressive disorderMosher (2018)ICD91 year26,476Rx_3-6OR0.92 (0.82, 1.03)Depressive disorderDaoust (2017)ICD91 year39,833Rx_>6OR1.32 (1.13, 1.53)Depressive disorderSun (2016)ICD91 year641,941Rx_>6OR1.15 (-, -)Depressive disorderSchoenfeld (2017)ICD91 year9,991Rx_>6HR0.84 (0.77, 0.9)Disruptive disordersBrummett (2017)CCS-AHRQ1 year36,177Rx_3-6OR1.03 (0.78, 1.34)Mental health care visitMosher (2018)VHA1 year26,476Rx_3-6OR0.98 (0.89, 1.07)Other psychiatric disorderBrummett (2017)CCS-AHRQ1 year36,177Rx_3-6OR0.85 (0.67, 1.08)Psychiatric disorderJohnson (2016)ICD91 year59,725Rx_3-6OR1.1 (1, 1.2)PsychosisSun (2016)ICD91 year641,941Rx_>6OR1.03 (0.68, 1.55)Peri-event factors(type of surgery or trauma)Elective surgery (ref: trauma surgery)Johnson (2016)TMSD--59,725Rx_3-6OR1.2 (1.1, 1.3)Major surgery (ref: minor surgery)Brummett (2017)MA--36,177Rx_3-6OR1.09 (0.96, 1.23)Back surgical procedure: decompression (ref: lumbar interbody arthrodesis)Schoenfeld (2017)MDR--9,991Rx_>6HR1.34 (1.25, 1.43)Back surgical procedure: discectomy (ref: lumbar interbody arthrodesis)Schoenfeld (2017)MDR--9,991Rx_>6HR1.43 (1.36, 1.5)Back surgical procedure: lumbar posterolateral arthrodesis (ref: lumbar interbody arthrodesis)Schoenfeld (2017)MDR--9,991Rx_>6HR1.03 (0.95, 1.12)Surgery type: pelvis or acetabulum (ref: lower extremity)Holman (2013)MA--613Rx_3-6RR1.33 (0.91, 1.94)Surgery type: upper extremity (ref: lower extremity)Holman (2013)MA--613Rx_3-6RR0.68 (0.36, 1.27)Surgery type: CABG via sternotomy (ref: open prostatectomy)Clarke (2014)OHIP--39,140Rx_3-6OR0.95 (0.71, 1.29)Surgery type: minimally invasive lung resection (ref: open prostatectomy)Clarke (2014)OHIP--39,140Rx_3-6OR1.95 (1.36, 2.78)Surgery type: minimally invasive colorectal surgery (ref: open prostatectomy)Clarke (2014)OHIP--39,140Rx_3-6OR1 (0.76, 1.32)Surgery type: minimally invasive hysterectomy (ref: open prostatectomy)Clarke (2014)OHIP--39,140Rx_3-6OR0.45 (0.33, 0.62)Surgery type: minimally invasive prostatectomy (ref: open prostatectomy)Clarke (2014)OHIP--39,140Rx_3-6OR0.37 (0.14, 1.01)Surgery type: open colorectal surgery (ref: open prostatectomy)Clarke (2014)OHIP--39,140Rx_3-6OR0.84 (0.67, 1.07)Surgery type: open hysterectomy (ref: open prostatectomy)Clarke (2014)OHIP--39,140Rx_3-6OR0.73 (0.55, 0.98)Surgery type: open lung resection (ref: open prostatectomy)Clarke (2014)OHIP--39,140Rx_3-6OR2.58 (2.03, 3.28)ISS score ≥ 15Daoust (2017)QTR--39,833Rx_>6OR0.81 (0.69, 0.95)Number of injuries = 2 (ref: 1)Daoust (2017)QTR--39,833Rx_>6OR1.01 (0.92, 1.1)Number of injuries ≥ 3 (ref: 1)Daoust (2017)QTR--39,833Rx_>6OR0.95 (0.85, 1.07)Face injuryDaoust (2017)QTR--39,833Rx_>6OR1.08 (0.95, 1.24)Head injuryDaoust (2017)QTR--39,833Rx_>6OR0.97 (0.84, 1.11)Lower extremity injuryDaoust (2017)QTR--39,833Rx_>6OR1.25 (1.15, 1.36)Spine injuryDaoust (2017)QTR--39,833Rx_>6OR1.62 (1.46, 1.8)Thorax injuryDaoust (2017)QTR--39,833Rx_>6OR1.15 (1.03, 1.28)Neck painBrummett (2017)QTR--36,177Rx_3-6OR1.22 (1.07, 1.39)Trauma with surgery (ref: trauma without surgery)Daoust (2017)QTR--39,833Rx_>6OR0.99 (0.91, 1.07)Trauma with surgery (ref: trauma without surgery)Al Dabbagh (2014)ICD9--639Rx_>6HR1.1 (0.9, 1.4)Trauma with surgery (ref: trauma without surgery)Weiss (2012) MA--396Rx_>6HR0.9 (0.7, 1.3)Fall mechanism unspecified (ref: same level fall)Al Dabbagh (2014)ICD9--639Rx_>6HR1.0 (0.5, 1.8)Fall mechanism unspecified (ref: same level fall)Al Dabbagh (2016) ICD10--891Rx_>6HR0.8 (0.6, 1.0)Fall mechanism other (ref: same level fall)Al Dabbagh (2014)ICD9--639Rx_>6HR1.1 (0.8, 1.4)Fall mechanism other (ref: same level fall)Al Dabbagh (2016) ICD10--891Rx_>6HR1.1 (0.7, 1.5)Fall mechanism unknown (ref: same level fall)Al Dabbagh (2014)ICD9--639Rx_>6HR0.9 (0.6, 1.2)Fall mechanism unknown (ref: same level fall)Al Dabbagh (2016) ICD10--891Rx_>6HR1.0 (0.7, 1.3)Fall mechanism transport accident (ref: same level fall)Al Dabbagh (2014)ICD9--639Rx_>6HR0.9 (0.7, 1.2)Fall mechanism transport accident (ref: same level fall)Al Dabbagh (2016)ICD10--891Rx_>6HR1.1 (0.9, 1.4)Fall mechanism transport accident (ref: same level fall)Weiss (2012) MA--396Rx_>6HR1.2 (0.8, 1.9)Fall mechanism – from height (ref: same level fall)Al Dabbagh (2014)ICD9--639Rx_>6HR0.8 (0.6, 1.1)Fall mechanism – from height (ref: same level fall)Al Dabbagh (2016)ICD10--891Rx_>6HR1.2 (0.8, 1.8)Fall mechanism – from height (ref: same level fall)Weiss (2012)MA--396Rx_>6HR1.1 (0.7, 1.8)Fracture type – open (ref: closed)Al Dabbagh (2014)ICD9--639Rx_>6HR0.9 (0.7, 1.1)Fracture type – open (ref: closed)Al Dabbagh (2016)ICD10--891Rx_>6HR0.6 (0.4, 1.0)Fracture type – unspecified (ref: closed)Al Dabbagh (2014)ICD9--639Rx_>6HR0.6 (0.4, 0.9)Fracture type – unspecified (ref: closed)Al Dabbagh (2016) ICD10--891Rx_>6HR0.9 (0.7, 1.2)Injury: mva (ref: falls)Daoust (2017)QTR--39,833Rx_>6OR0.87 (0.75, 1)Injury: other (ref: falls)Daoust (2017)QTR--39,833Rx_>6OR1.15 (0.97, 1.37)Injury: weapon or blunt object (ref: falls)Daoust (2017)QTR--39,833Rx_>6OR0.98 (0.73, 1.31)Peri- event factors (medication)OME total dose during surgical window ≥ 300mg (ref: < 300mg)Brummett (2017)MA--36,177Rx_3-6OR1.12 (1.03, 1.27)Number of days’ supply of first prescription: 8-14 days (ref: ≤7days)Mosher (2018)VHA--26,476Rx_3-6OR1.24 (1.12, 1.37)Number of days’ supply of first prescription: 15-29 days (ref: ≤7days)Mosher (2018)VHA--26,476Rx_3-6OR1.56 (1.39, 1.76)Number of days’ supply of first prescription ≥ 30 days (ref: ≤7days)Mosher (2018)VHA--26,476Rx_3-6OR2.59 (2.35, 2.86)Daily morphine equivalent (mg): 15.01 to ≤30 (ref: ≤15)Mosher (2018)VHA--26,476Rx_3-6OR1.11 (1.02, 1.21)Daily morphine equivalent (mg): 30.01 to ≤45 (ref: ≤15)Mosher (2018)VHA--26,476Rx_3-6OR1.18 (1.05, 1.33)Daily morphine equivalent (mg): > 45 (ref: ≤15)Mosher (2018)VHA--26,476Rx_3-6OR1.7 (1.49, 1.94)Type of opioid prescribed: Oxycodone (ref: Hydrocodone)Mosher (2018)VHA--26,476Rx_3-6OR0.96 (0.88, 1.05)Type of opioid prescribed: Tramadol (ref: Hydrocodone)Mosher (2018)VHA--26,476Rx_3-6OR1.55 (1.39, 1.72)Type of opioid prescribed: other (ref: Hydrocodone)Mosher (2018)VHA--26,476Rx_3-6OR1.23 (1.05, 1.45)Opioid prescription filled within 3month of trauma (ref: no opioid prescription filled)Daoust (2017)RAMQ--39,833Rx_>6OR3.05 (2.83, 3.29)Peri-event factors -acute postope-rativelyPerioperative complications (ref: no complications)Schoenfeld (2017)MDR--9,991Rx_>6HR1.05 (0.94, 1.17)Length of hospitalization (days)Schoenfeld (2017)MDR--9,991Rx_>6HR1 (0.99, 1)Discharged to rehab (ref: discharged home)Kim (2017)OCDMD--7,425Rx_>6OR2.24 (1.21, 4.13)ComorbiditiesCharlson comorbidity scoreBrummett (2017)ICD91 year36,177Rx_3-6OR1.1 (1.08, 1.13)Comorbidity score (20 diseases examined)Kim (2017)OCDMD1 year7,425Rx_>6OR1.25 (1.08, 1.44)Charlson comorbidity score = 1 (ref: 0)Schoenfeld (2017)ICD91 year9,991Rx_>6HR0.94 (0.89, 1)Charlson comorbidity score = 2+ (ref: 0)Schoenfeld (2017)ICD91 year9,991Rx_>6HR1.06 (0.94, 1.2)Elixhauser score = 2 (ref: ≤1)Johnson (2016)ICD91 year59,725Rx_3-6OR1.4 (1.3, 1.5)Elixhauser score = 3 (ref: ≤1)Johnson (2016)ICD91 year59,725Rx_3-6OR1.6 (1.4, 1.7)Elixhauser score = >3 (ref: ≤1)Johnson (2016)ICD91 year59,725Rx_3-6OR2.2 (2, 2.3)Endo/ MetabDiabetesClarke (2014)ICD103 years39,140Rx_3-6OR1.15 (1, 1.31)Onco-logyMalignancy: metastatic (ref: no malignancy)Clarke (2014)ICD103 years39,140Rx_3-6OR1.41 (0.88, 2.25)Malignancy: primary (ref: no malignancy)Clarke (2014)ICD103 years39,140Rx_3-6OR1.05 (0.91, 1.21)Respi-ratoryPulmonary diseaseClarke (2014)ICD103 years39,140Rx_3-6OR1.53 (1.7, 1.99)VascularCoronary artery diseaseClarke (2014)ICD103 years39,140Rx_3-6OR0.95 (0.75, 1.21)Cerebrovascular disorderClarke (2014)ICD103 years39,140Rx_3-6OR1.06 (0.71, 1.58)Heart failureClarke (2014)ICD103 years39,140Rx_3-6OR1.32 (1.02, 1.74)HypertensionClarke (2014)ICD103 years39,140Rx_3-6OR1.06 (0.92, 1.23)Peripheral vascular diseaseClarke (2014)ICD103 years39,140Rx_3-6OR0.85 (0.57, 1.2)Renal diseaseClarke (2014)ICD103 years39,140Rx_3-6OR1.01 (0.74, 1.39)Note: Rx_3-6 = opioid prescription 3-6 months post-event; Rx_>6 = opioid prescription > 6 months post-event; OR = Odds ratio; HR = Hazard ratio, SSRI: selective serotonin reuptake inhibitor; MA: medico-administrative database/medical records; ICD: International Classification of Diseases (when available, the version number is written next to the ICD acronym); CCS-AHRQ: Clinical Classification System from the Agency of Healthcare Research and Quality; OHIP: Ontario Health Insurance Plan; ODBD: Ontario Drug Benefit Database; QTR: Quebec Trauma Registry; RAMQ: Régie de l’assurance maladie du Québec; UCSB: Utah Controlled Substance Database; TMSD: Truven MarketScan Database; MDR: Military Health System Data Repository; OCDMD: Optum Clinformatics Data Mart Database; VHA: Veterans Health AffairsSupplemental Table 7. Results of individual risk factors for opioid prescription 3-6 months and >6 months post-surgery or trauma among individuals with prolonged opioid prescription pre-eventRisk factor categoryRisk factorStudiesData source for risk factorPeriod considered preop/ pretraumaNOut-come Type of effect sizeEffect size (95% CI)SociodemographicFemale sex (ref: male sex)Qureshi (2018)----1,321Rx_3-6OR0.88 (0.71, 1.10)Female sex (ref: male sex)Kim (2018)----54Rx_3-6OR0.38 (0.08, 1.84)Female sex (ref: male sex)Hadlandsmyth (2018)----1,229Rx_>6RR0.91 (0.74, 1.11)Female sex (ref: male sex)Hansen (2017)----720Rx_>6OR0.81 (0.57, 1.15)Age (10yrs increment)Inacio (2016)----593Rx_3-6OR0.96 (0.93, 0.99)Age: 70-80 (ref: < 70)Kim (2018)----54Rx_3-6OR0.22 (0.02, 2.12)Age: 38-60 (ref: 80+)Hansen (2017)----720Rx_>6OR0.32 (0.18, 0.58)Age: 61-80 (ref: 80+)Hansen (2017)----720Rx_>6OR0.67 (0.48, 0.95)Age: 60-70 (ref: <60)Hadlandsmyth (2018)----1,229Rx_>6RR0.99 (0.89, 1.1)Age: 70+ (ref: <60)Hadlandsmyth (2018)----1,229Rx_>6RR0.92 (0.79, 1.09)Race: African American (ref: White)Hadlandsmyth (2018)----1,229Rx_>6RR1.01 (0.88, 1.15)Race: other (ref: White)Hadlandsmyth (2018)----1,229Rx_>6RR1.19 (0.9, 1.58)Race: unknown (ref: White)Hadlandsmyth (2018)----1,229Rx_>6RR1.16 (0.96, 1.39)Health behaviorsTobacco dependenceQureshi (2018)ICD94 months1,321Rx_3-6OR1.96 (1.56, 2.46)Tobacco dependence Kim (2018)MA3 months54Rx_3-6OR6.94 (0.49, 97.52)Drug dependenceHadlandsmyth (2018)ICD91 year1,229Rx_>6RR0.95 (0.83, 1.08)Alcohol dependenceQureshi (2018)ICD94 months1,321Rx_3-6OR0.9 (0.56, 1.44)Pre-event medication useAntidepressant current use (ref: none in the past year)Hadlandsmyth (2018)VHA1 year1,229Rx_>6RR1.27 (1.02, 1.59)Antidepressant in the past year (ref: none in the past year) Hadlandsmyth (2018)VHA1 year1,229Rx_>6RR1.1 (0.97, 1.24)Antiepileptic current use (ref: none in the past year)Hadlandsmyth (2018)VHA1 year1,229Rx_>6RR0.89 (0.59, 1.34)Antiepileptic in the past year (ref: none in the past year)Hadlandsmyth (2018)VHA1 year1,229Rx_>6RR1.13 (1.02, 1.26)Benzodiazepine current use (ref: none in the past year)Hadlandsmyth (2018)VHA1 year1,229Rx_>6RR1.06 (0.79, 1.44)Benzodiazepine in the past year (ref: none in the past year)Hadlandsmyth (2018)VHA1 year1,229Rx_>6RR1.09 (0.98, 1.21)Hypnotic current use (ref: none in the past year)Hadlandsmyth (2018)VHA1 year1,229Rx_>6RR0.8 (0.55, 1.17)Hypnotic in the past year (ref: none in the past year)Hadlandsmyth (2018)VHA1 year1,229Rx_>6RR1.03 (0.91, 1.17)Preoperative hypnotic useInacio (2016)DVA1 year593Rx_3-6OR2.52 (1.48, 4.3)Muscle relaxant current use (ref: none in the past year)Hadlandsmyth (2018)VHA1 year1,229Rx_>6RR0.9 (0.67, 1.19)Muscle relaxant in the past year (ref: none in the past year)Hadlandsmyth (2018)VHA1 year1,229Rx_>6RR1.1 (0.99, 1.22)Average OME (10mg increment)Inacio (2016)DVA1 year593Rx_3-6OR1.06 (1, 1.11)Pre-event OME >12mg dailyKim (2018)MA3 months54Rx_3-6OR5.97 (0.49, 72.23)Pre-event opioid use (ref: no opioid use pre-event)Qureshi (2018)PDD4 months1,321Rx_3-6OR3.4 (NA, NA)Number of day using opioids pre-event = 157-224 (ref: 94-156)Inacio (2016)DVA1 year593Rx_3-6OR3.63 (2.08, 6.34)Number of days using opioids pre-event ≥ 225 (ref: 94-156)Inacio (2016)DVA1 year593Rx_3-6OR5.18 (2.92, 9.19)NSAIDHansen (2017)DVA1 year720Rx_>6OR1 (0.7, 1.43)MSK conditionBack painInacio (2016)ICD101 year593Rx_3-6OR1.99 (1.2, 3.23)Back painHansen (2017)ICD101 year720Rx_>6OR0.57 (0.3, 1.08)Chronic painHadlandsmyth (2018)ICD91 year1,229Rx_>6RR1.07 (0.96, 1.2)FibromyalgiaQureshi (2018)ICD94 months1,321Rx_3-6OR2.12 (1.56, 2.89)Primary gonarthrosisHansen (2017)ICD101 year720Rx_>6OR1.12 (0.87, 1.45)NeuroMigraine Qureshi (2018)ICD94 months1,321Rx_3-6OR1.42 (1.02, 1.97)Migraine Inacio (2016)ICD101 year593Rx_3-6OR1.76 (0.18, 17.25)Psychiatric diagnosesDepressive disorder Qureshi (2018)ICD94 months1,321Rx_3-6OR1.63 (1.29, 2.05)Depressive disorderInacio (2016)ICD101 year593Rx_3-6OR1.14 (0.67, 1.95)Psychiatric disorderKim (2018)MA3 months54Rx_3-6OR1.53 (0.21, 5.29)Psychiatric disorder Hadlandsmyth (2018)ICD91 year1,229Rx_>6RR0.97 (0.87, 1.09)PsychosisInacio (2016)ICD101 year593Rx_3-6OR1.47 (0.39, 5.42)Peri-operative factorsBilateral surgery (ref: unilateral surgery)Hansen (2017)DVA--720Rx_>6OR1.08 (0.72, 1.59)Length hospitalization (days)Hadlandsmyth (2018)VHA--1,229Rx_>6RR1 (1, 1)Length hospitalization: 11-20 days (ref: <11)Hansen (2017)DVA--720Rx_>6OR0.97 (0.63, 1.49)Length hospitalization ≥ 21 days (ref: <11)Hansen (2017)DVA--720Rx_>6OR1.47 (0.73, 2.94)Posttraumatic osteoarthritisKim (2018)MA--54Rx_3-6OR2.02 (0.35, 11.62)Use of NSAID post-traumaHansen (2017)DVA--720Rx_>6OR0.98 (0.69, 1.39)ComorbiditiesCharlson comorbidity score = 1-2 (ref: 0)Hansen (2017)ICD101 year720Rx_>6OR0.81 (0.55, 1.16)Charlson comorbidity score ≥ 3 (ref: 0)Hansen (2017)ICD101 year720Rx_>6OR1.14 (0.45, 2.86)Number of comorbidities = 2-3 (ref: <2) (algorithm based on Elixhauser)Hadlandsmyth (2018)ICD91 year1,229Rx_>6RR1.14 (0.98, 1.33)Number of comorbidities = 4-5 (ref: <2) (algorithm based on Elixhauser)Hadlandsmyth (2018)ICD91 year1,229Rx_>6RR1.15 (0.97, 1.35)Number of comorbidities = >5 (ref: <2) (algorithm based on Elixhauser)Hadlandsmyth (2018)ICD91 year1,229Rx_>6RR1.1 (0.89, 1.36)VascularCerebrovascular diseaseKim (2018)MA3 months54Rx_3-6OR6.77 (0.71, 64.92)HypertensionKim (2018)MA3 months54Rx_3-6OR0.27 (0.04, 1.87)HypertensionInacio (2016)ICD101 year593Rx_3-6OR0.98 (0.59, 1.63)Hypertension or ischemic heart diseaseInacio (2016)ICD101 year593Rx_3-6OR0.66 (0.41, 1.07)Renal diseaseKim (2018)MA3 months54Rx_3-6OR0.95 (0.05, 18.17)Venous thromboembolism Kim (2018)MA3 months54Rx_3-6OR2.66 (0.04, 72.63)Endo/metabDiabetesQureshi (2018)ICD94 months1,321Rx_3-6OR1.39 (NA, NA)Diabetes with complicationsInacio (2016)ICD101 year593Rx_3-6OR3.52 (1.05, 11.8)Diabetes without complicationsInacio (2016)ICD101 year593Rx_3-6OR1.89 (0.78, 4.57)BMI: overweight/obese (ref: normal)Hadlandsmyth (2018)VHA1 year1,229Rx_>6RR0.84 (0.7, 1)BMI: unknown (ref: normal)Hadlandsmyth (2018)VHA1 year1,229Rx_>6RR0.81 (0.65, 1.02)ObesityQureshi (2018)ICD94 months1,321Rx_3-6OR2.12 (NA, NA)GastroLiver disease (severe of failure)Inacio (2016)ICD101 year593Rx_3-6OR1.25 (0.59, 2.66)Syst/RheumInflammatory diseaseQureshi (2018)ICD94 months1,321Rx_3-6OR1.85 (NA, NA)Rheumatoid arthritis or collage vascular diseaseInacio (2016)ICD101 year593Rx_3-6OR1.01 (0.25, 4.71)Note: Rx_3-6 = opioid prescription 3-6 months post-event; Rx_>6 = opioid prescription > 6 months post-event; OR = Odds ratio; HR = Hazard ratio; VHA: Veterans Health Affairs; ICD: International Classification of Diseases (when available, the version number is written next to the ICD acronym); PDD: PearlDiver database; MA: medico-administrative records; DVA: Department of Veterans Affairs ................
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