Factors Associated With New Persistent Opioid Usage After Lung Resection

Abstract

Background-Opioid dependence, misuse, and abuse in the United States continue to rise. Prior studies indicate an important risk factor for persistent opioid use includes elective surgical procedures, though the probability following thoracic procedures remains unknown. We analyzed the incidence and factors associated with new persistent opioid use after lung resection Methods-We evaluated data from opioid-naïve cancer patients undergoing lung resection between 2010 and 2014 using insurance claims from the Truven Health MarketScan Databases. New persistent opioid usage was defined as continued opioid prescription fills between 90 and 180 days following surgery. Variables with p<0.10 by univariate analysis were included in a multivariable logistic regression performed for risk adjustment. Multivariable results were each reported with odds ratio (OR) and confidence interval (CI) Results-3,026 patients (44.8% male; 55.2% female) were identified as opioid-naïve undergoing lung resection. Mean age was 64 ± 11 years and mean postoperative length of stay (LOS) was 5.2±3.3 days. 6.5% underwent neoadjuvant therapy, while 21.7% underwent adjuvant therapy. Among opioid-naïve patients, 14% continued to fill opioid prescriptions following lung resection. Multivariable analysis showed that age ≤ 64 (OR 1.28 [CI 1.03-1.59], p=0.028), male sex (1.40 [1.13-1.73], p=0.002), postoperative LOS (1.32 [1.05-1.65], p=0.016), thoracotomy (1.58 [1.24-2.02], p<0.001), and adjuvant therapy (2.19 [1.75-2.75], p<0.001) were independent risk factors for persistent opioid usage Conclusions-The greatest risk factors for persistent opioid use (14%) following lung resection were adjuvant therapy and thoracotomy. Future studies should focus on reducing excess prescribing, perioperative patient education, and safe opioid disposal.

Intraoperative Intercostal Nerve Cryoanalgesia Improves Pain Control After Descending and Thoracoabdominal Aortic Aneurysm Repairs

“…1 Persistent pain is experienced in 50% to 60% of patients who undergo thoracotomy, 2,14 and new persistent opioid usage is reported in 14%. 3 In the current study the amount of narcotic use was significantly less with application of intercostal nerve cryoanalgesia after postoperative day 4, and by postoperative day 8 more than half of the patients in the cryoanalgesia group did not require opioids for pain control and 16% in the control group were opioid-free. Thus, cryoanalgesia may potentially reduce future opioid abuse and save healthcare costs in patients undergoing descending thoracic and thoracoabdominal aortic surgery.…”

“…However, uncontrolled acute pain not only leads to poor short-term outcomes but may also lead to chronic pain 1,2 and persistent opioid use. 3 A number of drugs are available for postoperative pain control, such as opioids, nonsteroidal antiinflammatory drugs (NSAIDs), central desensitizing analgesics (eg, gabapentin), local anesthetic agents, and combined regimens and protocols. 4 Opioid use is the backbone of postoperative pain control but comes with risks.…”

Predicting Persistent Opioid Use, Abuse, and Toxicity Among Cancer Survivors

“…10,26,[42][43][44] Other factors associated with opioid risk identified in this study such as race, median income, non-abusive alcohol use, comorbidity, BMI and cancer type have not been previously reported. 42,45,46 We found no association between gender and persistent opioid use, which differs from other studies, 10,26,28,43 though one must consider the skewed gender distribution of our study population within the VA healthcare system. Many patient, cancer and treatment related factors were consistently predictive of the three opioid-related study endpoints which likely stems from persistent opioid use being a mediator for downstream adverse opioids events.…”

“…Similar to prior studies, patients were defined as opioid naïve if no prescriptions were filled from one to twelve months prior to their first day of treatment. [24][25][26] Prior chronic opioid use was defined as having filled equal to or more than 120 days' supply of opioids between one to twelve months before treatment, or three opioid prescriptions from three to six months prior to treatment. 24,25,27 Intermittent opioid use was defined as any opioid use from one to twelve months prior to treatment that did not meet criteria for chronic opioid use.…”

New‐onset persistent opioid use following breast cancer treatment in older adult women

“…We anticipated the alternative outcome definition to be a more inclusive measure of persistent opioid use than our chosen measure of a 90-day opioid supply received in a 12-month period. 21,[35][36][37][38]…”