Patterns and predictors of outpatient opioid use after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy

Abstract

2019) Patterns and predictors of outpatient opioid use after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy, International ABSTRACT Background: Long-term opioid use is a well-known complication after surgery. In this retrospective study of adults who had undergone cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC), we sought to determine the rates and factors associated with outpatient opioid use within the sixth and twelfth postoperative months. Methods: Records of 288 opioid-naïve patients were included. Logistic regression models were used to determine factors prognostic of outpatient opioid use. Results: The median patient age was 54 years, and 63% were female. Rates of outpatient opioid use within the sixth and twelfth postoperative months were 21 and 13%, respectively. In the multivariate analysis, every doubling in the amount of in-hospital postoperative opioid consumption was associated with a 44% increase in odds of opioid use within the sixth postoperative month (OR 1.44, 95% CI 1.11-1.87, p ¼ .006) and a 70% increase within the twelfth postoperative month (OR 1.70, 95% CI 1.70-2.37, p ¼ .001). Other factors associated with opioid use within the sixth postoperative month included physical status (OR 5.26, 95% CI 1.08-25.55, p ¼ .039) and recent additional surgery (OR 23.02, 95% CI 2.03-261.30, p ¼ .011). Age (OR 4.39, 95% CI 1.77-10.89, p ¼ .001) and tumor grade (OR 3.31, 95% CI 1.31-8.41, p ¼ .012) were associated with opioid use within the twelfth postoperative month. Conclusion: In this study, the amount of in-hospital postoperative opioid consumption was an important contributory factor to outpatient opioid use in the sixth and twelfth postoperative months. SYNOPSISIn this study of adults who had undergone CRS-HIPEC, higher postoperative opioid consumption during hospitalization was associated with higher odds of opioid use within the sixth and twelfth postoperative months. ARTICLE HISTORY

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

“…These covariates were chosen by expert opinion and from previous publications. [6][7][8]26,[32][33][34][35][36][37][38] The preoperative psycho-social scores used the Patient Reported Outcome Measurement System scores (Physical Function short form 4a, Anxiety short form 4a, and Depression short form 4a). 29 Subjects with missing covariate data were included in outcome models using 20-fold multiple chain imputation techniques to replace missing values; imputation algorithms were predictive mean matching (numeric data), logistic regression (factors with two levels), and polytomous regression (factors with three or more levels).…”

“…In the selection of information to collect, we aimed to include variables that were likely relevant to the primary outcomes of prolonged postsurgical opioid use and pain. The selection was guided by experts we had among our authors and previous publications, [6][7][8]26,[32][33][34][35][36][37][38] and aided by an internal peer review process within the Multicenter Perioperative Outcomes Group consortium, while-for the manually collected information-attempting to limit the number of variables to a number that would not overwhelm data collectors and participants.…”