Abstract

Background: The number of older adults being discharged to a skilled nursing facility (SNF) after surgery continues to rise. Prior studies have shown that gabapentinoid prescribing after surgery is increasing, though this work only studied patients transitioning from hospital to home. Therefore, we aim to describe both use and prolonged use of gabapentinoids for older adults who are discharged to SNF and then home after surgery.

Methods: We conducted a retrospective analysis by merging patient data from Medicare Carrier, MedPAR, and Outpatient Files with Medicare Part D for 2013-2020. We included patients ≥ 66 years at time of procedure undergoing one of 14 common surgeries performed in older adults whose discharge was to SNF then home.

Results: The total study cohort included 79,417 patients who were discharged to a SNF. Median length of SNF stay was 15 days (IQR 10, 22 days). A total of 3182 (4%) received a new gabapentinoid prescription. Of these, 38% (n = 1219) had prolonged use. On multivariable logistic regression, we found that female sex, gabapentinoid days supply, emergency surgery, non-orthopedic and nonvascular surgery, and higher area deprivation index were associated with prolonged use.

Conclusions: Of our cohort, 38% had prolonged use, more than 1.5 times the proportion of prolonged use found in a past study among patients being discharged directly home. Importantly, patients who were sicker and more disadvantaged were more likely to have prolonged use. Our study highlights that additional work needs to focus on understanding and preventing inappropriate prolonged use of gabapentinoids after SNF discharge.