Perioperative factors associated with persistent opioid use after extensive abdominal surgery in children and adolescents: A retrospective cohort study

Owusu-Agyemang, Pascal; Cata, Juan P.; Meter, Antoinette Van; Kapoor, Ravish; Zavala, Acsa M.; Williams, Uduak Ursula; Tsai, January; Rebello, Elizabeth; Feng, Lei; Hayes‐Jordan, Andrea

doi:10.1111/pan.13386

Cited by 15 publications

(13 citation statements)

References 34 publications

(84 reference statements)

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“…In comparison to traditional single and/or mean measures of pain, examining pain in relation to time by trajectory analysis may offer more insight on the impact of different acute postoperative experiences on long-term outcomes [6]. Four unique acute pain trajectories were identified.…”

Section: Discussionmentioning

confidence: 99%

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Predicting Acute Postoperative Pain Trajectories and Long-Term Outcomes of Adolescents after Spinal Fusion Surgery

Ocay

Ingelmo

et al. 2020

Pain Research and Management

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Objectives. Acute pain trajectories are associated with long-term outcomes such as persistent pain and functional disability in adults. However, there are limited data on acute postoperative pain trajectories in the pediatric population. The aims of this study were to investigate acute postoperative pain trajectories, their predictors, and their impact on long- term outcomes in adolescents with idiopathic scoliosis. Methods. We evaluated the preoperative pain intensity, use of analgesics, psychosocial measures and physical functioning of adolescents scheduled to undergo spinal fusion, and their average 6-hour self-reported pain intensity scores for their entire hospital stay. Six months after surgery, baseline variables were reassessed. We used growth mixture modeling to conduct acute postoperative pain trajectory analysis and to identify predictors of pain trajectories. Generalized linear models were conducted to determine whether acute pain trajectories predict long-term outcomes. Results. One hundred and six patients were included in the best-fitted acute pain trajectory model that included four classes that differed in initial pain intensity and rates of change over time. Preoperative pain catastrophizer status and use of analgesics significantly predicted pain trajectory membership. Furthermore, at the 6-month follow-up, patients experiencing moderate-to-severe pain in the acute postoperative period were more likely to report higher levels of pain severity, use pain medication, and miss a greater number of school/work days due to back pain in the last three months. Discussion. Preoperative assessment and analyzing the progression of pain in the acute postoperative period can help identify those at risk of negative long-term outcomes after surgery.

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Section: Discussionmentioning

confidence: 99%

“…Acute postsurgical pain has been shown to predict chronic pain and opioid use in children and adolescents [6,7]. Moreover, the persistent nature of postoperative pain may delay rehabilitation [4,8].…”

Section: Introductionmentioning

confidence: 99%

Predicting Acute Postoperative Pain Trajectories and Long-Term Outcomes of Adolescents after Spinal Fusion Surgery

Ocay

Ingelmo

et al. 2020

Pain Research and Management

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“…In that study, perioperative opioid consumption of 300 oral morphine equivalents was associated with a 14% increase in the risk of new persistent opioid use [1]. In our previous study of persistent opioid use after CRS-HIPEC in children, higher levels if in-hospital opioid consumption after surgery was associated with higher odds of persistent opioid use at 6 months [15].…”

Section: Discussionmentioning

confidence: 77%

“…The majority (66%) had low-grade tumors, and neoadjuvant chemotherapy was used in 30% of the patients. The median PCI (IQR) was 17 (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25), and a CC score of zero was achieved in most (69%) of the patients. Further details of intraoperative and postoperative management are presented in Table 1.…”

Section: Patient Characteristicsmentioning

confidence: 99%

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

Owusu-Agyemang

Cata

Kapoor

et al. 2019

International Journal of Hyperthermia

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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

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“… 7 , 8 In those patients, high opioid consumption is an independent risk factor for postoperative adverse outcomes, delayed recovery and persistent postoperative opioid use. 9 …”

Section: Introductionmentioning

confidence: 99%

Impact of Ketamine on Opioid Use and Persistent Pain After Cytoreductive Surgery with Hyperthermic Chemotherapy

Cata¹,

Owusu-Agyemang²,

Koyyalagunta³

et al. 2021

JPR

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Background Persistent pain and opioid use can be devastating after cytoreductive surgery (CRS) and hyperthermic intraoperative chemotherapy (HIPEC). Methods We conducted a retrospective study to investigate the impact of ketamine use on postoperative complications and persistent and chronic pain after CRS-HIPEC. Results Ketamine reduced perioperative opioid use before and after implementation of recovery after surgery programs. Ketamine did not impact the formation of persistent and chronic pain formation and long-term opioid use. Postoperative complications and postoperative re-operations were independent predictors of persistent pain. Interestingly, the risk of having a complication was increased by 1% for every doubling in opioids used intraoperatively. Conclusion Ketamine use reduces perioperative opioid consumption in patients undergoing CRS-HIPEC, but it is not associated with improvements in long-term opioid use and chronic pain.

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Perioperative factors associated with persistent opioid use after extensive abdominal surgery in children and adolescents: A retrospective cohort study

Abstract: In this retrospective study of children and adolescents who had undergone a major oncologic surgery, higher in-patient pain scores and higher postoperative opioid consumption were associated with a persistent opioid use of up to 6 months.

Cited by 15 publications

References 34 publications

Predicting Acute Postoperative Pain Trajectories and Long-Term Outcomes of Adolescents after Spinal Fusion Surgery

Predicting Acute Postoperative Pain Trajectories and Long-Term Outcomes of Adolescents after Spinal Fusion Surgery

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

Impact of Ketamine on Opioid Use and Persistent Pain After Cytoreductive Surgery with Hyperthermic Chemotherapy

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