Frailty status as a potential factor in increased postoperative opioid use in older adults

Abstract

Background Prescription opioids are commonly used for postoperative pain relief in older adults, but have the potential for misuse. Both opioid side effects and uncontrolled pain have detrimental impacts. Frailty syndrome (reduced reserve in response to stressors), pain, and chronic opioid consumption are all complex phenomena that impair function, nutrition, psychologic well-being, and increase mortality, but links among these conditions in the acute postoperative setting have not been described. This study seeks to understand the relationship between frailty and patterns of postoperative opioid consumption in older adults. Methods Patients ≥ 65 years undergoing elective surgery with a planned hospital stay of at least one postoperative day were recruited for this cohort study at pre-anesthesia clinic visits. Preoperatively, frailty was assessed by Edmonton Frailty and Clinical Frailty Scales, pain was assessed by Visual Analog and Pain Catastrophizing Scales, and opioid consumption was recorded. On the day of surgery and subsequent hospitalization days, average pain ratings and total opioid consumption were recorded daily. Seven days after hospital discharge, patients were interviewed using uniform questionnaires to measure opioid prescription use and pain rating. Results One hundred seventeen patients (age 73.0 (IQR 67.0, 77.0), 64 % male), were evaluated preoperatively and 90 completed one-week post discharge follow-up. Preoperatively, patients with frailty were more likely than patients without frailty to use opioids (46.2 % vs. 20.9 %, p = 0.01). Doses of opioids prescribed at hospital discharge and the prescribed morphine milligram equivalents (MME) at discharge did not differ between groups. Seven days after discharge, the cumulative MME used were similar between cohorts. However, patients with frailty used a larger fraction of opioids prescribed to them (96.7 % (31.3, 100.0) vs. 25.0 % (0.0, 83.3), p = 0.007) and were more likely (OR 3.7, 95 % CI 1.13–12.13) to use 50 % and greater of opioids prescribed to them. Patients with frailty had higher pain scores before surgery and seven days after discharge compared to patients without frailty. Conclusions Patterns of postoperative opioid use after discharge were different between patients with and without frailty. Patients with frailty tended to use almost all the opioids prescribed while patients without frailty tended to use almost none of the opioids prescribed.

Bidirectional association between visual impairment and frailty among community-dwelling older adults: a longitudinal study

“…On the one hand, frailty has been associated with behaviors which may increase ocular disease risk, such as low physical activity [ 16 ]. On the other hand, older adults with frailty usually take opioids to relieve disease-related pain symptom, which may cause damage to vision [ 17 ]. Therefore, vision impairment and frailty may be linked in a two-way fashion, which may produce a downward spiral, where each in turn triggers the other.…”

Serratus plane block versus standard of care for pain control after totally endoscopic aortic valve replacement: a double-blind, randomized controlled, superiority trial

“… 28 Furthermore, in the population above 65 years, high frailty rather than younger age is the primary predictor for increased postoperative opioid consumption. 29 Patients randomized to the SAPB group in our study appeared to be more frail as indicated by their lower SF-36 physical component summary scores. 30 However, they consumed significantly less opioids in the postoperative phase.…”

Association of preoperative functional disability with chronic postsurgical pain: A prospective observational study

“…Frailty prior to surgery has been associated with postoperative acute pain and CPSP at 3 months after surgery; however, these mechanisms are poorly documented (Alvarez‐Nebreda et al, 2018; Auckley et al, 2021). Although few reports have investigated the relationship between functional disability measured using the WHODAS 2.0 and frailty instruments, 12‐item WHODAS 2.0 scores moderately correlated with activities of daily living in outpatients and surgical patients (Fujiwara et al, 2021; Ida et al, 2017).…”