Chronic Opioid Usage in Surgical Patients in a Large Academic Center

Jiang, Xueying; Orton, M R N Jodi; Feng, Rui; Hossain, Erik; Malhotra, Neil R.; Zager, Eric L.; Liu, Renyu

doi:10.1097/sla.0000000000001780

Cited by 187 publications

(153 citation statements)

References 37 publications

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“…Previous studies assessing patterns of opioid use after surgery among opioid‐naïve patients report varying proportions of patients using opioids during the postoperative period. At 90 days after surgery, across a number of studies, the proportion of opioid users varied between 3.1% and 13.5%, with significant variation by procedure . After 12 months, Alam et al .…”

Section: Discussionsupporting

confidence: 54%

“…At 90 days after surgery, across a number of studies, the proportion of opioid users varied between 3.1% and 13.5%, 2,6,11-13 with significant variation by procedure. 6,13 After 12 months, Alam et al 14 found that 10.3% of patients had used opioids continually since their operation. Evidently, there will be a relatively small proportion of patients who persistently use opioids for a long time after surgery, and the results of the present study reflect this in our Australian population.…”

Section: Discussionmentioning

confidence: 99%

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Investigation of opioid prescribing in the postoperative setting among opioid‐naïve surgical patients: a 6‐month observational study

Hilmer

Crane

MacPherson

et al. 2019

Pharmacy Practice and Res

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There is sparse information on patterns of opioid use among opioid‐naïve surgical patients. This prospective observational study investigated patterns of opioid prescribing after hospital discharge, opioid use at 1 week and 1, 3 and 6 months after discharge, and associations between opioid use, pain control and opioid‐related difficulties in opioid‐naïve surgical patients (age ≥18 years, not prescribed opioids in the previous 12 months, expected hospital length of stay >24 h after surgery). Of 128 participants recruited, 56.3% (n = 72) were male with a median (interquartile range) age of 66 (50.7–73.0) years; 38.3% (n = 49) were discharged with an opioid prescription postoperatively. After discharge, 37.3% (n = 25/67), 12.3% (n = 8/65), 12.5% (n = 6/48) and 2.4% (n = 1/42) of participants had used an opioid within 1 week and 1, 3 and 6 months, respectively. Low levels of pain were experienced overall postoperatively. There was considerable variation in opioid‐related problems and concerns over time, with the most common being the desire to cease the opioid. Follow‐up response rates were low, which limits the conclusions that can be drawn from the data. However, the findings indicate that opioids are commonly prescribed at discharge to opioid‐naïve surgical patients, with significant decline in use over time.

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Section: Discussionsupporting

confidence: 54%

Section: Discussionmentioning

confidence: 99%

Investigation of opioid prescribing in the postoperative setting among opioid‐naïve surgical patients: a 6‐month observational study

Hilmer

Crane

MacPherson

et al. 2019

Pharmacy Practice and Res

View full text Add to dashboard Cite

show abstract

“…When examining the surgical population as a whole, including patients taking opioids prior to surgery, postoperative chronic opioid use ranges from 9.2 to 13%. 58,59 In the context of the current opioid crisis, measures to decrease the overall prevalence of chronic opioid use after surgery will decrease opioid-related adverse events including opioid misuse, abuse, addiction, diversion, respiratory depression and overdose.…”

Section: Persistent or Chronic Opioid Use After Surgerymentioning

confidence: 99%

Chronic Opioid Use After Surgery: Implications for Perioperative Management in the Face of the Opioid Epidemic

Hah

Bateman

Ratliff³

et al. 2017

Anesthesia &Amp; Analgesia

560

221

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Physicians, policymakers, and researchers are increasingly focused on finding ways to decrease opioid use and overdose in the United States both of which have sharply increased over the past decade. While many efforts are focused on the management of chronic pain, the use of opioids in surgical patients presents a particularly challenging problem requiring clinicians to balance two competing interests: managing acute pain in the immediate postoperative period and minimizing the risks of persistent opioid use following the surgery. Finding ways to minimize this risk is particularly salient in light of a growing literature suggesting that post-surgical patients are at increased risk for chronic opioid use. The perioperative care team, including surgeons and anesthesiologists, is poised to develop clinical and systems-based interventions aimed at providing pain relief in the immediate postoperative period while also reducing the risks of opioid use longer term. In this paper, we discuss the consequences of chronic opioid use following surgery, and present an analysis of the extent to which surgery has been associated with chronic opioid use. We follow with a discussion of the risk factors that are associated with chronic opioid use after surgery, and proceed with an analysis of the extent to which opioid sparing perioperative interventions (e.g., nerve blockade) have been shown to reduce the risk of chronic opioid use following surgery. We then conclude with a discussion of future research directions.

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“…The definitions of opioid therapy during the time windows within the follow-up time were not strict and many definitions only required one opioid prescription during a predefined time period for LTOT. 40,[43][44][45][46][47][48][49][50][51][52][53][54] For example, one study defined LTOT as at least one prescription 305 to 425 days after a hospital discharge. 44 By only requiring one prescription during a specified window of time after the index date, these definitions fail to identify consistent use.…”

Section: /1002 = 57%mentioning

confidence: 99%

Long‐term opioid therapy definitions and predictors: A systematic review

Karmali

Bush

Raman

et al. 2019

Pharmacoepidemiology and Drug

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Purpose This review sought to (a) describe definitions of long‐term opioid therapy (LTOT) outcome measures, and (b) identify the predictors associated with the transition from short‐term opioid use to LTOT for opioid‐naïve individuals. Methods We conducted a systematic review of the peer‐reviewed literature (January 2007 to July 2018). We included studies examining opioid use for more than 30 days. We classified operationalization of LTOT based on criteria used in the definitions. We extracted LTOT predictors from multivariate models in studies of opioid‐naïve individuals. Results The search retrieved 5,221 studies, and 34 studies were included. We extracted 41 unique variations of LTOT definitions. About 36% of definitions required a cumulative duration of opioid use of 3 months. Only 17% of definitions considered consecutive observation periods, 27% used days' supply, and no definitions considered dose. We extracted 76 unique predictors of LTOT from seven studies of opioid‐naïve patients. Common predictors included pre‐existing comorbidities (21.1%), non‐opioid prescription medication use (13.2%), substance use disorders (10.5%), and mental health disorders (10.5%). Conclusions Most LTOT definitions aligned with the chronic pain definition (pain more than 3 months), and used cumulative duration of opioid use as a criterion, although most did not account for consistent use. Definitions were varied and rarely accounted for prescription characteristics, such as days' supply. Predictors of LTOT were similar to known risk factors of opioid abuse, misuse, and overdose. As LTOT becomes a central component of quality improvement efforts, researchers should incorporate criteria to identify consistent opioid use to build the evidence for safe and appropriate use of prescription opioids.

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Chronic Opioid Usage in Surgical Patients in a Large Academic Center

Cited by 187 publications

References 37 publications

Investigation of opioid prescribing in the postoperative setting among opioid‐naïve surgical patients: a 6‐month observational study

Investigation of opioid prescribing in the postoperative setting among opioid‐naïve surgical patients: a 6‐month observational study

Chronic Opioid Use After Surgery: Implications for Perioperative Management in the Face of the Opioid Epidemic

Long‐term opioid therapy definitions and predictors: A systematic review

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