Preoperative Opioid Use Highly Prevalent, Associated With Age, Tobacco Use

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Patients’ self-reported pain severity, life satisfaction, centralized pain characteristics, and anxiety and depression status at baseline were examined.
Patients’ self-reported pain severity, life satisfaction, centralized pain characteristics, and anxiety and depression status at baseline were examined.

Preoperative opioid use was reported by approximately 23% of patients undergoing surgery, with age, tobacco use, depression, poor life satisfaction, and medical comorbidities identified as independent factors associated with pre-interventional opioid use, according to a study published in JAMA Surgery.

For this cross-sectional study, investigators prospectively collected data from 34,186 patients from the Michigan Genomics Initiative and Analgesic Outcomes Study. Patients' self-reported pain severity, life satisfaction, centralized pain characteristics, and anxiety and depression status at baseline were examined. The researchers also assessed whether patients were taking opioids prior to surgery by examining anesthesia electronic health record data.

A total of 7894 patients (23.1%) in this cohort reported using opioids preoperatively, including hydrocodone bitartrate (59.4%), tramadol hydrochloride (21.2%), and oxycodone hydrochloride (18.3%). Independent factors found to be associated with presurgical opioid use were age (31-40 years vs <31 years; adjusted odds ratio [aOR], 1.26; 95% CI, 1.10-1.45; P <.001), tobacco use (former use: aOR, 1.32; 95% CI, 1.22-1.42; P <.001; current use: aOR, 1.62; 95% CI, 1.48-1.78; P <.001), depression (aOR, 1.22; 95% CI, 1.12-1.33; P <.001), and multiple medical comorbidities (American Society of Anesthesiology score: aOR, 1.47; 95% CI, 1.37-1.58; P <.001; Charlson Comorbidity Index: aOR, 1.29; 95% CI, 1.18-1.41; P <.001).

In addition, illicit opioid drug use (aOR, 1.74; 95% CI, 1.16-2.60; P =.007), higher pain severity (aOR, 1.33; 95% CI, 1.31-1.35; P <.001), higher Fibromyalgia Survey scores (aOR, 1.06; 95% CI, 1.05-1.07), and lower life satisfaction (aOR, 0.95; 95% CI, 0.93-0.96; P <.001) were also found to be associated with preoperative opioid use in this cohort. 

After adjusting for patient characteristics, preoperative opioid use was found to be more likely to be reported in patients undergoing procedures involving the lower extremities (aOR, 3.61; 95% CI, 2.81-4.64; P <.001), the pelvis (excluding hip; aOR, 3.09; 95% CI, 1.88-5.08; P <.001), upper extremities (aOR, 3.07; 95% CI, 2.12-4.45; P <.001), and spine or spinal cord (aOR, 2.68; 95% CI, 2.15-3.32; P <.001).

Limitations of the study include the predominantly white patient population as well as the exclusion of patients undergoing procedures at other smaller, nonacademic hospitals.

“Current opioid use has significant implications in pain management, and surgeons must be able to identify these patients and establish a safe and effective acute pain management plan that may include preoperative reduction of opioid use, naloxone rescue strategies at discharge, and a rational plan of postoperative opioid prescribing,” noted the study authors.

Reference

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Hilliard PE, Waljee J, Moser S, et al. Prevalence of preoperative opioid use and characteristics associated with opioid use among patients presenting for surgery [published online July 11, 2018]. JAMA Surg. doi: 10.1001/jamasurg.2018.2102

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