Impact of Preoperative Opioid Use After Emergency General Surgery

Kim, Young; Cortez, Alexander R.; Wima, Koffi; Dhar, Vikrom K.; Athota, Krishna P.; Schrager, Jason; Pritts, Timothy A.; Edwards, Michael J.; Shah, Shimul A.

doi:10.1007/s11605-017-3665-x

Cited by 35 publications

(22 citation statements)

References 19 publications

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“…Patients with previous or current opioid use are at higher risk for persistent use or opioidrelated adverse events after surgery. [32][33][34] Acute-on-chronic opioid consumption may increase the risk of overdose, and duplicate prescriptions potentially supply patients with excess medication for later use or diversion. 35 For patients with preoperative opioid use, surgeons should check Prescription Drug Monitoring programs before writing refills and communicate with a patient's usual prescriber to coordinate which provider will supply continuing prescriptions.…”

Section: Discussionmentioning

confidence: 99%

Classifying Preoperative Opioid Use for Surgical Care

Vu¹,

Cron²,

Lee³

et al. 2018

Annals of Surgery

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Objective: We characterized patterns of preoperative opioid use in patients undergoing elective surgery to identify the relationship between preoperative use and subsequent opioid fill after surgery. Background: Preoperative opioid use is common, and varies by dose, recency, duration, and continuity of fills. To date, there is little evidence to guide postoperative prescribing need based on prior opioid use. Methods: We analyzed claims data from Clinformatics® DataMart Database for patients aged 18-64 years undergoing major and minor surgery between 2008 and 2015. Preoperative use was defined as any opioid prescription filled in the year before surgery. We used cluster analysis to group patients by the dose, recency, duration, and continuity of use. Our primary outcome was second postoperative fill within 30 postoperative days. Our primary explanatory variable was opioid use group. We used logistic regression to examine likelihood of second fill by opioid use group. Results: Out of 267,252 patients, 102,748 (38%) filled an opioid prescription in the 12 months before surgery. Cluster analysis yielded 6 groups of preoperative opioid use, ranging from minimal (27.6%) to intermittent (7.7%) to chronic use (2.7%). Preoperative opioid use was the most influential predictor of second fill, with larger effect sizes than other factors even for patients with minimal or intermittent opioid use. Increasing preoperative use was associated with risk-adjusted likelihood of requiring a second opioid fill compared to naïve patients (minimal use:

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Section: Discussionmentioning

confidence: 99%

Classifying Preoperative Opioid Use for Surgical Care

Vu¹,

Cron²,

Lee³

et al. 2018

Annals of Surgery

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“…Preoperative opioid use has also been linked to poorer outcomes across most major surgical specialties (23)(24)(25)(26)(27)(28)(29)(30). These adverse outcomes have been widely documented using measures such as length of stay (27,30), readmission rate (23,27,28), postoperative cost of care (24,25,31), and complication rate (25). Among orthopedic patient populations, who often have high rates of use prior to surgery (32), preoperative opioid abuse and dependence is associated with significant increases in morbidity and mortality after surgery (33).…”

Section: Risks Associated With Opioid Use Prior To Surgerymentioning

confidence: 99%

The Surgeon's Role in the Opioid Crisis: A Narrative Review and Call to Action

et al. 2020

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“…10 Although persistent opioid use may have a role for some patients to allow function and maintain quality of life, opioid use has been shown to be associated with several deleterious aspects of health. These include overdose, 17 poor compliance with treatment recommendations, 18 operative morbidity and mortality, [1][2][3][4][5][6] and risk of subsequent opioid dependence for family members, 19 among many others.…”

Section: Commentmentioning

confidence: 99%

“…However, postoperative morbidity related to opioid therapy can be severe. [1][2][3][4][5][6] Furthermore, chronic use may develop, which is helping to fuel the opioid crisis. 7 From 2001 to 2016, opioid-related deaths in the United States increased 345%.…”

mentioning

confidence: 99%

Persistent Opioid Use Among the Elderly After Lung Resection: A SEER-Medicare Study

Nelson

Niu

Mitchell

et al. 2020

The Annals of Thoracic Surgery

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Background. Opioids represent the mainstay for treating postsurgical pain but can cause significant morbidity in addition to dependency. The aim of the study was to determine the incidence of persistent opioid use after lung surgery. Methods. Patients who underwent lung resection from 2008 to 2013 for non-small cell lung cancer were identified in the Surveillance, Epidemiology and End Results-Medicare database. Patients were categorized as being chronic, intermittent, or naïve preoperative opioid users using information obtained from part D records. Persistent opioid use was defined as having a filled opioid prescription between 3 and 6 months after lung resection. Results. A total of 6948 patients were identified, among whom 3946 (56.8%) were opioid naïve, 2017 (29.0%) were intermittent opioid users, and 985 (14.2%) were chronic opioid users preoperatively. Persistent opioid use (3-6 months) after lung resection was high (31%), even among Patients and Methods Data Source The Surveillance, Epidemiology and End Results (SEER)-Medicare linked database was queried to identify the cohort for this study. 12 The SEER database maintains

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Impact of Preoperative Opioid Use After Emergency General Surgery

Cited by 35 publications

References 19 publications

Classifying Preoperative Opioid Use for Surgical Care

Classifying Preoperative Opioid Use for Surgical Care

The Surgeon's Role in the Opioid Crisis: A Narrative Review and Call to Action

Persistent Opioid Use Among the Elderly After Lung Resection: A SEER-Medicare Study

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