Postoperative Gabapentinoid, Opioid Prescribing Rose Among Older Adults

The prescribing of gabapentinoids after surgery has increased, but there has not been a decrease in the number of patients also receiving opioids, resulting in an increase in concurrent prescriptions of both medications, according to study findings published in JAMA Network Open.

In a serial cross-sectional study of gabapentinoid prescribing from January 1, 2013, through December 31, 2018, researchers sought to describe the trends in postoperative prescribing of gabapentinoids and opioids. The researchers examined nationally representative Medicare data that included a 20% US Medicare sample. Patients who were aged 66 and older and had not previously taken gabapentinoids who underwent 1 of 14 common noncataract surgeries performed in older adults were included in the study. The data analysis period was from April 2022 to April 2023.

For the study, the researchers focused on 2 main measures: the rate of prescribing gabapentinoids and opioids after surgery, including prescriptions filled 7 days before and after discharge, and using gabapentinoids and opioids simultaneously during the postoperative period.

A total of 494,922 patients (mean age, 73.7; 53.9% women) were included in the study. Most patients were White (86.0%); 5.1% were Hispanic, and 4.9% were Black. Of these, 3.7% received a new gabapentinoid prescription in the postoperative period.

Gabapentin prescribing patterns showed minimal variation by race and ethnicity. However, gabapentin prescribing patterns varied by procedure type. Common procedures that included new gabapentinoid prescriptions included:

• total knee arthroplasty (6.0%),
• total hip arthroplasty (5.9%),
• lumbar laminotomy or lumbar laminectomy (4.6%), and
• laparoscopic cholecystectomy (4.3%).

Overall, between 2014 and 2018, the rate of new postoperative gabapentinoid prescribing increased from 2.3% (95% CI, 2.2%-2.4%) to 5.2% (95% CI, 5.0%-5.4%); P <.001.

This increase was seen across almost all procedure types, along with an increase in opioid prescribing from 56% (95% CI, 55%-56%) to 59% (95% CI, 58%-60%); P <.001. Mean oral morphine equivalents (OMEs) did vary; mean OMEs were 436 in 2014, 471 in 2015, and 379 in 2018 (P <.01). An ONE of 436 is equivalent to 58 5-mg tablets of oxycodone and an OME of 379 is equivalent to 51 5-mg tablets of oxycodone.

Concomitant prescribing also rose from 1.6% (95% CI, 1.5%-1.7%) to 4.1% (95% CI, 4.0%-4.3%); P <.001.

These findings indicate a significant increase in prescription rates over the 5-year study period.

Among several study limitations, patients who received their supply of medications from the hospital pharmacy might have been missed. In the study, the researchers only analyzed data up until 2018 due to medical data availability, so any changes in more recent years were not studied.

The researchers concluded, “[N]ew postoperative gabapentinoid prescribing is rising, without a downward trend in the proportion of patients receiving postoperative opioid prescribing.”