New and Persistent Controlled Substance Use Among Patients Undergoing Mastectomy and Reconstructive Surgery
Bibliographic record
Abstract
Abstract PurposeProlonged use of controlled substances can place patients at increased risk of dependence and complications. Women who have mastectomy and reconstructive surgery (M+R) may be vulnerable to becoming new persistent users (NPUs) of opioid and sedative-hypnotic medications.MethodsUsing the MarketScan health care claims database, we identified opioid- and sedative-hypnotic-naïve women who had M+R from 2008-2017. Women who filled ≥1 peri-operative prescription and ≥2 post-operative prescriptions within one year after surgery were classified as NPUs. Univariate and multivariable logistic regression analyses were used to estimate rates of new persistent use and predictive factors. Risk summary scores were created based on the sum of associated factors.ResultsWe evaluated 25,270 opioid-naïve women and 27,651 sedative-hypnotic-naïve women.We found that 18,931 opioid-naïve women filled a peri-operative opioid prescription, and of those, 3,315 (17.5%) became opioid NPUs post-operatively. Additionally, 10,781 sedative-hypnotic-naïve women filled a peri-operative sedative-hypnotic prescription, and of those, 1,837 (17.0%) became sedative-hypnotic NPUs. Development of new persistent sedative-hypnotic use was associated with age ≤49 (OR 1.79 [95% CI 1.43–2.25]) and age 50-64 (1.65 [1.31-2.07]) compared to age ≥65; Medicaid insurance (1.92 [1.23–2.98]); southern residence (1.38 [1.20–1.59]); breast cancer diagnosis (1.78 [1.09–2.91]); and chemotherapy (2.24 [2.02–2.49]). Risk of NPU increased with higher risk score. Women with ≥3 of these risk factors were three times more likely to become sedative-hypnotic NPUs than patients with 0 or 1 factors (3.03 [2.60–3.53]). Comparable findings were seen regarding new persistent opioid use.ConclusionWomen who have M+R are at risk of developing both new persistent opioid and new persistent sedative-hypnotic use. A patient’s risk of becoming an NPU increases as their number of risk factors increases. Non-pharmacologic strategies are needed to manage pain and anxiety following cancer-related surgery.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".