Article Figures & Tables
Figures
- Figure 1:
Cohort creation flowchart for patients undergoing same-day breast surgery in Ontario, Canada, during the study period (July 1, 2012, to June 30, 2020). Final cohort of n = 84 369 represents number of unique first surgeries and number of patients.
- Figure 2:
Categorization of opioids filled by patients within 7 days of same-day breast surgery during the study period. For a listing of agents included in the “Other” category, see Appendix 3, Appendix Table 3 (available at www.cmajopen.ca/content/11/2/E208/suppl/DC1).
- Figure 3:
Filling of opioid prescriptions by postoperative day. Most prescriptions were filled on the day of surgery (postoperative day 0).
Tables
- Table 1:
Characteristics of patients undergoing same-day breast surgery in Ontario, Canada, during the study period, categorized by filling of opioid prescriptions within 7 days of surgery date (n = 84 369)*
Variable No. (%)† who filled opioid prescription, days 0–7 No. (%)† who did not fill opioid prescription No. (%)† of all patients Standardized difference Any opioid prescription filled up to 7 d after surgery 60 620 23 749 84 369 N/A Sex Female 59 627 (71.9) 23 319 (28.1) 82 946 (98.3) 0.013 Male 993 (69.8) 430 (30.2) 1423 (1.7) 0.013 Age at surgery date, yr Median (IQR) 58 (48–68) 59 (48–69) 58 (48–68) 0.074 Age, yr 18–29 3230 (71.0) 1320 (29.0) 4550 (5.4) 0.01 30–39 4146 (71.3) 1669 (28.7) 5815 (6.9) 0.007 40–49 10 158 (73.5) 3656 (26.5) 13 814 (16.4) 0.037 50–59 15 411 (73.9) 5429 (26.1) 20 840 (24.7) 0.06 60–69 14 992 (72.1) 5793 (27.9) 20 785 (24.6) 0.008 70–79 9471 (69.8) 4091 (30.2) 13 562 (16.1) 0.043 ≥ 80 3212 (64.2) 1791 (35.8) 5003 (5.9) 0.092 Charlson Comorbidity Index score 0–1 55 764 (72.5) 21 175 (27.5) 76 939 (91.2) 0.097 ≥ 2 4856 (65.4) 2574 (34.6) 7430 (8.8) 0.097 Socioeconomic status (quintiles) 1 (lowest) 10 490 (69.9) 4509 (30.1) 14 999 (17.8) 0.044 2 11 932 (72.1) 4626 (27.9) 16 558 (19.6) 0.005 3 12 265 (72.4) 4665 (27.6) 16 930 (20.1) 0.015 4 12 599 (72.4) 4809 (27.6) 17 408 (20.6) 0.013 5 (highest) 13 334 (72.2) 5140 (27.8) 18 474 (21.9) 0.009 Location of residence Missing data 80 (62.0) 49 (38.0) 129 (0.2) 0.018 Rural 6519 (69.9) 2808 (30.1) 9327 (11.1) 0.034 Urban 54 021 (72.1) 20 892 (27.9) 74 913 (88.8) 0.036 Hospital type Missing data 1966 (65.0) 1059 (35.0) 3025 (3.6) 0.063 Community 43 018 (74.3) 14 852 (25.7) 57 870 (68.6) 0.18 Pediatric 54 (40.3) 80 (59.7) 134 (0.2) 0.054 Small 299 (51.3) 284 (48.7) 583 (0.7) 0.077 Teaching 15 283 (67.2) 7474 (32.8) 22 757 (27.0) 0.139 Breast cancer diagnosis No 24 735 (67.0) 12 172 (33.0) 36 907 (43.7) 0.211 Yes 35 885 (75.6) 11 577 (24.4) 47 462 (56.3) 0.211 Type of procedure Excision partial breast only ± axillary intervention 51 855 (70.6) 21 569 (29.4) 73 424 (87.0) 0.164 Excision total breast ± axillary intervention 3698 (79.8) 938 (20.2) 4636 (5.5) 0.099 Excision radical breast ± axillary intervention 2175 (82.6) 458 (17.4) 2633 (3.1) 0.101 Bilateral surgery 2892 (78.7) 784 (21.3) 3676 (4.4) 0.075 Patients filling additional opioid prescription(s) within 7 d of surgery 0 additional 58 380 (100.0) 0 58 380 (69.2) 7.22 1 additional 1948 (100.0) 0 1948 (2.3) 0.258 2 additional 187 (100.0) 0 187 (0.2) 0.079 ≥ 3 additional 105 (100.0) 0 105 (0.1) 0.059 NA 0 23 749 (100.0) 23 749 (28.1) – Year of surgery 2012 3959 (69.3) 1751 (30.7) 5710 (6.8) 0.033 2013 8052 (73.1) 2956 (26.9) 11 008 (13.0) 0.025 2014 8604 (73.7) 3065 (26.3) 11 669 (13.8) 0.038 2015 8237 (74.1) 2879 (25.9) 11 116 (13.2) 0.044 2016 8029 (74.5) 2748 (25.5) 10 777 (12.8) 0.051 2017 7322 (71.4) 2938 (28.6) 10 260 (12.2) 0.009 2018 6923 (70.0) 2961 (30.0) 9884 (11.7) 0.032 2019 6774 (68.1) 3171 (31.9) 9945 (11.8) 0.066 2020 2720 (68.0) 1280 (32.0) 4000 (4.7) 0.042 - Table 2:
Median oral morphine equivalents (mg) filled within 7 days of same-day surgery in the cohort by procedure, institution and year of surgery during the study period*
Variable No. of patients Total OMEs, mg Median (IQR) Minimum value–maximum value p value† Overall 60 547 135 (90–180) 8–35 526 Type of procedure Excision partial breast only ± axillary intervention 51 798 135 (90–180) 8–35 526 < 0.0001 Excision total breast ± axillary intervention 3692 135 (100–200) 10–13 200 Excision radical breast ± axillary intervention 2172 150 (113–225) 20–6800 Bilateral surgery 2885 150 (113–225) 15–24 300 Hospital type Teaching 15 272 135 (90–180) 8–35 526 0.8377 Community 42 961 135 (90–180) 10–24 300 Small 296 135 (75–200) 23–1200 Pediatric 54 113 (68–225) 27–1800 Year of surgery 2012 3950 135 (113–225) 23–11 685 < 0.0001 2013 8044 135 (113–225) 15–21 600 2014 8596 135 (113–225) 8–24 300 2015 8223 135 (113–225) 15–35 526 2016 8016 135 (113–225) 19–19 575 2017 7317 135 (100–180) 15–13 050 2018 6916 113 (75–150) 15–8235 2019 6767 75 (50–113) 10–5580 2020 2718 75 (50–113) 10–18 180 - Table 3:
Unadjusted and adjusted analyses of factors associated with filling of opioid prescription within 7 days of same-day breast surgery (n = 84 369)
Characteristic Unadjusted RR (95% CI) Adjusted RR (95% CI) Age, yr 18–29 Ref. Ref. 30–39 1.00 (0.98–1.03) 0.97 (0.95–1.00) 40–49 1.04 (1.01–1.06) 0.98 (0.95–1.00) 50–59 1.04 (1.02–1.06) 0.97 (0.95–0.99) 60–69 1.02 (1.00–1.04) 0.93 (0.91–0.95) 70–79 0.98 (0.96–1.01) 0.89 (0.87–0.91) ≥ 80 0.90 (0.88–0.93) 0.80 (0.78–0.83) Breast cancer diagnosis Yes 1.13 (1.12–1.14) 1.16 (1.15–1.17) No Ref. Ref. Charlson Comorbidity Index score 0–1 Ref. Ref. ≥ 2 0.90 (0.89–0.92) 0.90 (0.89–0.92) Hospital type Missing 0.87 (0.85–0.90) 0.87 (0.85–0.89) Pediatric 0.54 (0.44–0.67) 0.56 (0.46–0.69) Small 0.69 (0.64–0.75) 0.72 (0.67–0.78) Teaching 0.90 (0.89–0.91) 0.90 (0.89–0.91) Community Ref. Ref. Location of residence Missing 0.89 (0.77–1.02) 0.92 (0.80–1.04) Urban 1.03 (1.02–1.05) 1.02 (1.00–1.03) Rural Ref. Ref. Sex Male 0.97 (0.94–1.00) 0.98 (0.95–1.02) Female Ref. Ref. Socioeconomic status (quintiles) 1 (lowest) Ref. Ref. 2 1.03 (1.02–1.05) 1.02 (1.01–1.04) 3 1.04 (1.02–1.05) 1.03 (1.01–1.04) 4 1.03 (1.02–1.05) 1.02 (1.01–1.04) 5 (highest) 1.03 (1.02–1.05) 1.03 (1.01–1.04) Type of procedure Excision total breast ± axillary intervention 1.13 (1.11–1.15) 1.12 (1.10–1.14) Excision radical breast ± axillary intervention 1.17 (1.15–1.19) 1.12 (1.10–1.14) Bilateral surgery 1.11 (1.09–1.13) 1.12 (1.10–1.14) Excision partial breast only ± axillary intervention Ref. Ref. Year of surgery 2012 Ref. Ref. 2013 1.05 (1.03–1.08) 1.05 (1.03–1.07) 2014 1.06 (1.04–1.09) 1.06 (1.04–1.08) 2015 1.07 (1.05–1.09) 1.06 (1.04–1.09) 2016 1.07 (1.05–1.10) 1.07 (1.05–1.09) 2017 1.03 (1.01–1.05) 1.02 (1.00–1.04) 2018 1.01 (0.99–1.03) 1.01 (0.98–1.03) 2019 0.98 (0.96–1.00) 0.98 (0.95–1.00) 2020 0.98 (0.95–1.01) 0.97 (0.94–0.99) Note: CI = confidence interval, Ref. = reference category, RR = risk ratio.
- Table 4:
Unadjusted and adjusted analyses of factors associated with filling more than 1 opioid prescription within 7 days of same-day breast surgery
Characteristic Unadjusted RR (95% CI) Fixed intercept adjusted RR (95% CI) Random intercept adjusted RR (95% CI)* Age, yr 18–29 Ref. Ref. Ref. 30–39 1.98 (1.56–2.53) 1.89 (1.47–2.42) 1.87 (1.48–2.36) 40–49 1.63 (1.30–2.04) 1.53 (1.21–1.94) 1.59 (1.25–2.02) 50–59 1.42 (1.14–1.77) 1.31 (1.03–1.65) 1.33 (1.04–1.69) 60–69 1.19 (0.95–1.49) 1.04 (0.82–1.33) 1.07 (0.84–1.37) 70–79 1.08 (0.85–1.37) 0.89 (0.69–1.15) 0.89 (0.69–1.15) ≥ 80 1.31 (1.00–1.73) 0.98 (0.73–1.31) 0.89 (0.67–1.18) Breast cancer diagnosis Yes 1.24 (1.14–1.35) 1.24 (1.12–1.36) 1.39 (1.26–1.53) No Ref. Ref. Ref. Charlson Comorbidity Index score 0–1 Ref. Ref. Ref. ≥ 2 1.83 (1.63–2.06) 1.69 (1.50–1.90) 1.50 (1.34–1.69) Hospital type Missing 0.85 (0.65–1.09) 0.87 (0.67–1.13) 0.69 (0.51–0.92) Pediatric 2.12 (0.83–5.46) 1.65 (0.67–4.06) 0.72 (0.25–2.05) Small 2.20 (1.48–3.28) 1.93 (1.28–2.90) 1.36 (0.87–2.11) Teaching 1.23 (1.12–1.34) 1.17 (1.06–1.28) 0.78 (0.68–0.90) Community Ref. Ref. Ref. Location of residence Missing 1.11 (0.42–2.90) 0.99 (0.38–2.57) 1.24 (0.45–3.37) Urban 0.80 (0.71–0.90) 0.81 (0.72–0.91) 1.00 (0.87–1.15) Rural Ref. Ref. Ref. Sex Male 1.74 (1.36–2.21) 1.38 (1.07–1.79) 1.06 (0.82–1.37) Female Ref. Ref. Ref. Socioeconomic status (quintiles) 1 (lowest) Ref. Ref. Ref. 2 0.83 (0.73–0.94) 0.85 (0.75–0.96) 0.88 (0.78–0.99) 3 0.75 (0.66–0.86) 0.77 (0.68–0.88) 0.80 (0.70–0.92) 4 0.79 (0.70–0.89) 0.81 (0.71–0.92) 0.86 (0.76–0.98) 5 (highest) 0.74 (0.65–0.84) 0.77 (0.68–0.88) 0.82 (0.72–0.93) Type of procedure Excision total breast ± axillary intervention 1.97 (1.73–2.26) 1.84 (1.60–2.11) 1.88 (1.63–2.17) Excision radical breast ± axillary intervention 2.49 (2.14–2.90) 2.09 (1.79–2.45) 2.24 (1.90–2.65) Bilateral surgery 2.48 (2.17–2.84) 2.22 (1.93–2.55) 1.98 (1.70–2.30) Excision partial breast only ± axillary intervention Ref. Ref. Ref. Year of surgery 2012 Ref. Ref. Ref. 2013 1.02 (0.83–1.24) 1.04 (0.86–1.27) 1.08 (0.86–1.36) 2014 1.14 (0.94–1.38) 1.16 (0.96–1.40) 1.26 (1.00–1.58) 2015 1.04 (0.85–1.26) 1.08 (0.88–1.31) 1.18 (0.94–1.47) 2016 1.05 (0.86–1.28) 1.10 (0.90–1.34) 1.22 (0.96–1.55) 2017 1.04 (0.85–1.27) 1.09 (0.89–1.33) 1.14 (0.90–1.44) 2018 1.09 (0.89–1.33) 1.13 (0.93–1.38) 1.19 (0.94–1.50) 2019 0.91 (0.74–1.12) 0.94 (0.77–1.16) 0.98 (0.76–1.27) 2020 1.31 (1.03–1.66) 1.25 (0.99–1.59) 1.30 (0.99–1.72) Note: CI = confidence interval, Ref. = reference category, RR = risk ratio.
↵* Random intercept adjusted risk ratio accounts for provider-level clustering.
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