Improving Opioid Prescribing Post-Discharge for Trauma Patients With Rib Fractures: Factors in Prevention of Prolonged Use and Dependency

King, Sarah A.; Harper, Christopher; Smith, Lou M.; Crismon, David; Heidel, Robert E; Hall, Genevieve; Beam, Zachary; Daley, Brian

doi:10.1177/00031348221082275

Cited by 2 publications

(1 citation statement)

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“…58 Findings in those studies included an association of prolonged postoperative opioid use with preoperative depression, anxiety, or mood disorders, 6,26,32 age and lower household income, 7 type of surgery, [6][7][8] preoperative pain, 23,32 preoperative use of opioids, 32,33,59 and discharge prescription of opioids. [59][60][61] No association was found between prolonged opioid use and nerve blocks 62,63 or minor versus major surgery. 26 Our prospective study included most of these factors, and did not confirm most findings of these retrospective studies, other than preoperative opioid use.…”

Section: Perioperative Medicinementioning

confidence: 95%

Prolonged Opioid Use and Pain Outcome and Associated Factors after Surgery under General Anesthesia: A Prospective Cohort Association Multicenter Study

et al. 2023

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Introduction There is insufficient prospective evidence regarding the relationship between surgical experience and prolonged opioid use and pain. We investigated the association of patient characteristics, surgical procedure, and perioperative anesthetic course with postoperative opioid consumption and pain three months post surgery. We hypothesized patient characteristics and intraoperative factors predict opioid consumption and pain three months post surgery. Methods Eleven U.S. and one European institution enrolled patients scheduled for spine, open thoracic, knee, hip, or abdominal surgery, or mastectomy in this multicenter, prospective observational study. Preoperative and postoperative data was collected using patient surveys and electronic medical records. Intra-operative data were collected from the Multicenter Perioperative Outcomes Group database. The association between postoperative opioid consumption and surgical site pain at three months, elicited from a telephone survey conducted at three months postoperatively, and demographics, psycho-social scores, pain scores, pain management, and case characteristics, was analyzed. Results Between September and October 2017, 3,505 surgical procedures met inclusion criteria. 1,093 cases were included; 413 patients were lost to follow-up, leaving 680 (64%) for outcome analysis. Preoperatively, 135 (20%) patients were taking opioids. Three months post surgery, 96 (14%) patients were taking opioids, including 23 patients (4%) who had not taken opioids preoperatively. 177 patients (27%) reported surgical site pain, including 45 (13%) patients who had not reported pain preoperatively. The adjusted odds ratio for 3-month opioid use was 18.6 (Credible Interval 10.3- 34.5) for patients who had taken opioids preoperatively. The adjusted odds ratio for three-month surgical site pain was 2.58 (1.45-4.4), 4.1 (1.73-8.9), and 2.75 (1.39-5.0) for patients who had site pain preoperatively, knee replacement, or spine surgery, respectively. Conclusions Preoperative opioid use was the strongest predictor of opioid use three months post surgery. None of the other variables showed clinically significant association with opioid use at three months after surgery.

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