{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T02:49:14Z","timestamp":1788922154677,"version":"build-2803163510"},"reference-count":44,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2025,6,16]],"date-time":"2025-06-16T00:00:00Z","timestamp":1750032000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["PM&amp;amp;R"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Despite targeted national quality improvement initiatives, opioid prescription and use patterns after lower limb amputation are not well studied.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To determine risk factors associated with extended opioid use and rates of high\u2010risk opioid prescribing after lower limb amputation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design and setting<\/jats:title>\n                    <jats:p>A retrospective population\u2010based study was performed by querying a 20% national sample of Medicare claims of patients undergoing lower limb amputation from 2009 to 2018. Patients were excluded if they did not discharge home or had subsequent surgery 180\u2009days after discharge. Extended opioid use was defined as one opioid prescription filled within 90\u2009days after discharge and another within 90\u2013180\u2009days. Chronic opioid users were defined as having a 180\u2010day supply over the preoperative surgical period and at least one opioid prescription within 60\u2009days of surgery. High\u2010risk opioid prescribing included overlapping opioid prescriptions, overlapping benzodiazepine\u2010opioid prescriptions, high daily doses &gt;100 oral morphine milligram equivalents, multiple prescribers, and new long\u2010acting opioid use within 90\u2009days postoperatively. Multilevel mixed\u2010effects logistic regression and the Cochran\u2013Armitage Trend Test was used.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome<\/jats:title>\n                    <jats:p>New persistent and prolonged opioid use following lower extremity amputation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The study included 5191 patients (nonchronic opioid users\u2009=\u20093759, chronic opioid users\u2009=\u20091432). Among the nonchronic opioid users, 873 (23.2%) had new persistent opioid use after surgery. In these patients, age\u2009&lt;\u200955\u2009years (odds ratio [OR], 1.41,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.04), concurrent gabapentinoid fills (OR, 1.92,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u2009.001), and sedative\/anxiolytic fills (OR, 1.75,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u2009.001) were associated with new persistent use. Of the chronic opioid users, 1306 (91.2%) had prolonged opioid use after surgery. Rates of high\u2010risk prescribing did not change significantly during the study period, and 82.3% of chronic opioid users were exposed to high\u2010risk prescribing.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Extended opioid use is common following lower extremity amputation. Moreover, high\u2010risk prescribing practices remain common and have not changed over time.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pmrj.13408","type":"journal-article","created":{"date-parts":[[2025,6,16]],"date-time":"2025-06-16T10:03:59Z","timestamp":1750068239000},"page":"1452-1463","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Opioid consumption after lower limb amputation in Medicare beneficiaries"],"prefix":"10.1002","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4192-423X","authenticated-orcid":false,"given":"Alexander N.","family":"Khouri","sequence":"first","affiliation":[{"name":"Department of Surgery, Section of Plastic Surgery University of Michigan  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nishant Ganesh","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Surgery, Section of Plastic Surgery University of Michigan  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3299-4612","authenticated-orcid":false,"given":"Hsou\u2010Mei","family":"Hu","sequence":"additional","affiliation":[{"name":"The Overdose Prevention Engagement Network (OPEN) University of Michigan Health System  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maryam","family":"Yazdanfar","sequence":"additional","affiliation":[{"name":"The Overdose Prevention Engagement Network (OPEN) University of Michigan Health System  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer F.","family":"Waljee","sequence":"additional","affiliation":[{"name":"Department of Surgery, Section of Plastic Surgery University of Michigan  Ann Arbor Michigan USA"},{"name":"The Overdose Prevention Engagement Network (OPEN) University of Michigan Health System  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theodore A.","family":"Kung","sequence":"additional","affiliation":[{"name":"Department of Surgery, Section of Plastic Surgery University of Michigan  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,6,16]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.2147\/JPR.S32299"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2007.11.005"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1080\/09638280410001708869"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/00002508\u2010200006001\u201000017"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.avsg.2014.12.005"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/AIA.0000000000000095"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1177\/2049463717736492"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0304\u20103959(00)00264\u20105"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2005.03.031"},{"issue":"5","key":"e_1_2_9_11_1","first-page":"227","article-title":"Prevalence and characteristics of chronic phantom limb pain among American veterans. Results of a trial survey","volume":"62","author":"Sherman RA","year":"1983","journal-title":"Am J Phys Med"},{"issue":"4","key":"e_1_2_9_12_1","first-page":"19","article-title":"Management of post\u2010amputation pain","volume":"103","author":"Modest JM","year":"2020","journal-title":"RI Med J"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.4103\/joacp.JOACP_126_17"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1093\/pm\/pnw110"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.7326\/M14\u20102559"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1586\/17512433.2014.928587"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.j.pain.0000460357.01998.f1"},{"key":"e_1_2_9_18_1","doi-asserted-by":"crossref","unstructured":"Prevention CfDCa.CDC Clinical Practice Guideline for Prescribing Opioids for Pain \u2014 United States 2022.https:\/\/www.cdc.gov\/mmwr\/volumes\/71\/rr\/rr7103a1.htm.","DOI":"10.15585\/mmwr.rr7103a1"},{"key":"e_1_2_9_19_1","unstructured":"Prevention CfDCa.CDC Guideline For Prescribing Opioids For Chronic Pain.https:\/\/www.cdc.gov\/drugoverdose\/pdf\/Guidelines_At-A-Glance-508.pdf."},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpain.2021.721357"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1177\/0363546518819780"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000003832"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000006588"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2018.08.057"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2017\u20102439"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2020.03.020"},{"key":"e_1_2_9_27_1","volume-title":"Lower Extremity Amputation","author":"Molina CS","year":"2024"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2020.04.019"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000005193"},{"key":"e_1_2_9_30_1","doi-asserted-by":"publisher","DOI":"10.1097\/GOX.0000000000004026"},{"key":"e_1_2_9_31_1","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.22.00607"},{"key":"e_1_2_9_32_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2013.278344"},{"key":"e_1_2_9_33_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000002458"},{"key":"e_1_2_9_34_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000003723"},{"key":"e_1_2_9_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.lana.2022.100302"},{"key":"e_1_2_9_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhsa.2020.04.011"},{"key":"e_1_2_9_37_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000009726"},{"key":"e_1_2_9_38_1","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0000000000002132"},{"key":"e_1_2_9_39_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11916\u2010021\u201000943\u20106"},{"key":"e_1_2_9_40_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000003941"},{"key":"e_1_2_9_41_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2017.4436"},{"key":"e_1_2_9_42_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000003483"},{"key":"e_1_2_9_43_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000002497"},{"key":"e_1_2_9_44_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.27481"},{"key":"e_1_2_9_45_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2020.3623"}],"container-title":["PM&amp;R"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pmrj.13408","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,18]],"date-time":"2025-12-18T13:47:03Z","timestamp":1766065623000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/pmrj.13408"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,16]]},"references-count":44,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2025,12]]}},"alternative-id":["10.1002\/pmrj.13408"],"URL":"https:\/\/doi.org\/10.1002\/pmrj.13408","archive":["Portico"],"relation":{},"ISSN":["1934-1482","1934-1563"],"issn-type":[{"value":"1934-1482","type":"print"},{"value":"1934-1563","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,16]]},"assertion":[{"value":"2024-07-23","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-03-14","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-06-16","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}