Risk of Chronic Opioid Use in Opioid-Naïve and Non-Naïve Patients after Ambulatory Surgery

Zaveri, Shruti; Nobel, Tamar; Khetan, Prerna; Divino, Celia M.

doi:10.1007/s11605-019-04265-2

Cited by 22 publications

(22 citation statements)

References 15 publications

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“…10 This study examined the effect that demographic and temporal factors, particularly the day of the week and the postoperative day at the time of discharge, might have on the amount of postoperative opioids prescribed by general surgeons. Although other studies have established that postoperative opioid prescriptions create a risk of chronic opioid dependence [6][7][8][9] and that the amount of postoperative MME prescribed by surgeons has decreased in recent years 10 (which was again reinforced in our study), to our knowledge, this is the first study specifically to examine patient-specific and temporal factors that might impact the amount of postoperative MME prescribed.…”

Section: Discussionmentioning

confidence: 52%

“…[1][2][3][4] Furthermore, studies have also demonstrated both that postoperative opioid use in previously opioid-naïve patients is a risk factor for chronic opioid addiction and abuse and that inappropriately high amounts of opioids prescribed after common general surgery procedures are associated with chronic opioid addiction. [5][6][7][8][9] To better address the role of prescription opioids in the current national epidemic, investigation into postoperative opioid prescribing patterns is warranted. Although the amount of opioids prescribed postoperatively for a given procedure varies widely, 10 the factors that influence such variability in postoperative prescribing patterns remains unknown.…”

Section: Introductionmentioning

confidence: 99%

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Variations in postoperative opioid prescribing by day of week and duration of hospital stay

Lazar

Zaveri

Khetan

et al. 2021

Surgery

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Section: Discussionmentioning

confidence: 52%

Section: Introductionmentioning

confidence: 99%

Variations in postoperative opioid prescribing by day of week and duration of hospital stay

Lazar

Zaveri

Khetan

et al. 2021

Surgery

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“…Complete uniformity in the definition of prolonged opioid use may not contribute to achieving these aims. For example, both the studies by Steen et al 18 and Zaveri et al 19 used the timepoint of 3 months after surgery to define prolonged opioid use after major limb amputation and minor outpatient surgery, respectively. Clinically, using 3 months to define prolonged opioid use for both major limb amputations and less invasive procedures such as a carpal tunnel release fails to account for the expected differences in both the intensity and duration of pain.…”

Section: Discussionmentioning

confidence: 99%

Prolonged Opioid Use following Hand Surgery: A Systematic Review and Proposed Criteria

Moura

Nicholson

Hoftiezer

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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Background: Prolonged opioid use after surgery has been a contributing factor to the ongoing opioid epidemic. The purpose of this systematic review is to analyze the definitions of prolonged opioid use in prior literature and propose appropriate criteria to define postoperative prolonged opioid use in hand surgery. Methods: Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines 130 studies were included for review. The primary outcome was the timepoint used to define prolonged opioid use following surgery. The proportion of patients with prolonged use and risk factors for prolonged use were also collected for each study. Included studies were categorized based on their surgical specialty. Results: The most common timepoint used to define prolonged opioid use was 3 months (n = 86, 67.2% of eligible definitions), ranging from 1 to 24 months. Although 11 of 12 specialties had a mean timepoint between 2.5 and 4.17 months, Spine surgery was the only outlier with a mean of 6.90 months. No correlation was found between the definition’s timepoint and the rates of prolonged opioid use. Conclusions: Although a vast majority of the literature reports similar timepoints to define prolonged postoperative opioid use, these studies often do not account for the type of procedures being performed. We propose that the definitions of postoperative prolonged opioid use should be tailored to the level and duration of pain for specific procedures. We present criteria to define prolonged opioid use in hand surgery.

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“…This finding is in agreement with previous work that described rates of NPOU after both major and minor ambulatory surgery between 5% and 10%; (5.9%-6.5%). 12,13,[34][35][36] However, no prior work focused on anorectal procedures. To our knowledge, only the work by Brummett et al included anorectal surgery, including hemorrhoidectomy in their ''minor surgery'' cohort, though the size of this case's contribution to the overall sample was undefined.…”

Section: Discussionmentioning

confidence: 99%

A Randomized Controlled Trial Examining the Impact of an Anorectal Surgery Multimodal Enhanced Recovery Program on Opioid Use

et al. 2020

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Background: Anorectal cases may be a common gateway to the opioid epidemic. Opioid reduction is inherent in enhanced recovery after surgery (ERAS) protocols, but little work has evaluated ERAS in these cases. Objective: To determine if ERAS could reduce postoperative opioid utilization in ambulatory anorectal surgery without sacrificing patient pain or satisfaction. Methods: A randomized controlled trial assigned ambulatory anorectal patients to ERAS (experimental) or routine care (surgeon's choice) for pain management (control) over 30-days postoperatively. Primary outcome was overall days of opioid use. Secondary outcomes included pain and satisfaction scores over multiple time points and new persistent opioid use. The Visual Analog Scale, Functional Pain Scale, and EQ-5D-3L measured patientreported pain and satisfaction. Univariate analysis compared outcomes overall and at individual time points. Two-way mixed ANOVA evaluated pain and satisfaction measures between groups and over time. Results: Thirty-two patients were randomized into each arm (64 total). The control group consumed significantly more opioids after discharge (median 121.3MME vs 23.5MME, P < 0.001). Significantly more control patients requested additional narcotics (P ¼ 0.004), made unplanned calls (P ¼ 0.009), and had unplanned clinic visits (P ¼ 0.003). The control group had significantly more days on opioids (mean 14.4 vs 2.2, P < 0.001). Three control patients (9.4%) versus no experimental patients had new persistent opioid use. The mean global health, EQ5D-3L, Visual Analog Scale, and Functional Pain scores were comparable between groups over time. Conclusions: An ERAS protocol in ambulatory anorectal surgery is feasible, and resulted in reduced opioid use, and healthcare utilization, with no difference in pain or patient satisfaction. This challenges the paradigm that extended opioids are needed for effective postoperative pain management.

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Risk of Chronic Opioid Use in Opioid-Naïve and Non-Naïve Patients after Ambulatory Surgery

Cited by 22 publications

References 15 publications

Variations in postoperative opioid prescribing by day of week and duration of hospital stay

Variations in postoperative opioid prescribing by day of week and duration of hospital stay

Prolonged Opioid Use following Hand Surgery: A Systematic Review and Proposed Criteria

A Randomized Controlled Trial Examining the Impact of an Anorectal Surgery Multimodal Enhanced Recovery Program on Opioid Use

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