Factors associated with prolonged use of newly prescribed gabapentinoids in older adults undergoing colorectal surgery

BACKGROUND: Gabapentinoids are one component of multimodal analgesia in enhanced recovery programs after colorectal surgery. Long-term use can be especially harmful in older adults. This study sought to identify factors associated with prolonged gabapentinoid use in older adults following colorectal surgery. METHODS: This retrospective cohort study analyzed data on a 20% representative sample of patients with Medicare. Patients were included if they were ≥ 66 years old, underwent colorectal surgery between October 1, 2015 and June 30, 2018, had continuous Part D enrollment during the time of operation, and were gabapentinoid naïve. Patients were excluded if they died within 180 days after surgery or were discharged to hospice or skilled nursing facility. The main outcome measure was prolonged gabapentinoid use, defined as prescription refills > 90 days after discharge, in those newly prescribed a gabapentinoid. RESULTS: Among the 979 patients who met inclusion criteria and had a new gabapentinoid prescription after colorectal surgery, 22% had prolonged gabapentinoid use. Concurrent peri-discharge opioid use was associated with reduced likelihood of prolonged gabapentinoid use (OR 0.48 [0.34, 0.66], p < 0.0001). In patients who had both opioid and gabapentinoid prescriptions at discharge, opioid use beyond 90 days was associated with prolonged gabapentinoid use (OR 3.45 [2.43, 4.89], p < 0.0001). Patients discharged home with home health services had increased likelihood of prolonged gabapentinoid use (OR 1.53 [1.08, 2.17], p = 0.047). CONCLUSIONS: Factors associated with prolonged gabapentinoid use after colorectal surgery in the older adult population include initial prescription of a gabapentinoid without opioids, prolonged opioid use beyond discharge, and discharge to home with health services. Identifying these factors may reveal potentially modifiable interventions to curb prolonged gabapentinoid use in this population.