A set of factors was found to be associated with greater opioid consumption after major surgery, according to study results published in the Annals of Surgery.
In this prospective observational study, 1181 opioid-naïve patients scheduled to undergo hysterectomy (n=275), thoracic surgery (n=135), or total knee (n=358) or hip (n=233) arthroplasty at a single center were enrolled. A total of 1001 of these patients self-reported their total opioid use in oral morphine equivalents (OME) 1 month after surgery, and 913 completed a battery of self-reported measures including several from the National Institutes of Health Patient-Reported Outcomes Measurement Information System (PROMIS).
The following factors were found to be associated with increased consumption of opioids: younger age (P <.001), non-white race (P =.037), lack of a college degree (P =.007), greater levels of anxiety (P =.003), greater sleep disturbance (P =.019), heavy alcohol use (P =.039), current tobacco use (P =.007), and larger initial opioid prescription size (P <.001).
The median total OME prescribed in the month after surgery was 600 mg (to the equivalent of 120 pills of 5 mg hydrocodone). The median consumption of opioids was 188 mg, or 38 pills. Overall, 628,475 mg OMEs were prescribed and 360,650 mg OMEs were consumed.
Study limitations include the potential for error due to differences in preoperative treatment, surgical and anesthesia techniques, postoperative complications, insurance coverage, and family or physician support.
“These data may be used to help personalize opioid prescribing, encourage the use of nonopioid adjunctive medications, and potentially recommend behavioral interventions to better manage acute and subacute postoperative pain,” noted the study authors.
Larach DB, Sahara MJ, As-Sanie S, et al. Patient factors associated with opioid consumption in the month following major surgery [published online August 5, 2019]. Ann Surg. doi: 10.1097/SLA.0000000000003509