Post-surgical opioid prescribing patterns and risk factors for additional opioid prescriptions within one year after non-emergent colorectal surgery

Lovely, Jenna K.; Huang, Lyen C.; Meyers, Abigail J.; Spears, Grant M.; Huebner, Marianne; Larson, David W.

doi:10.1016/j.amjsurg.2018.12.003

Cited by 3 publications

(2 citation statements)

References 24 publications

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“…PPOU is widely defined as the long-term use of opioids, for example, filling multiple opioid prescriptions within 90 to 180 days after discharge from surgery, 20 although various definitions exist. [21][22][23][24] The prevalence of PPOU varies due to the considerable variation in defining persistent use across studies, and the determinants of PPOU and its consequences are still inconclusive. 21 Currently, there is no robust evidence supporting the effectiveness of long-term opioid use.…”

Section: Introductionmentioning

confidence: 99%

“…[21][22][23][24] The prevalence of PPOU varies due to the considerable variation in defining persistent use across studies, and the determinants of PPOU and its consequences are still inconclusive. 21 Currently, there is no robust evidence supporting the effectiveness of long-term opioid use. Still, persistent and high-dose opioid use is closely related to opioid-related harm, such as dependence, misuse and adverse conditions (e.g.…”

Section: Introductionmentioning

confidence: 99%

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Prevalence and determinants of chronic pain and persistent opioid use after surgery: A review of systematic reviews

Bansal,

Ang,

Chen

2023

British Journal of Pain

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Background Chronic post-surgical pain (CPSP) and persistent post-operative opioid use (PPOU) are inconsistently defined in published literature. This review comprehensively summarised their definitions, prevalence and determinants from existing systematic reviews or meta-analyses. Methods Systematic reviews or meta-analyses evaluating the prevalence of CPSP and PPOU in adults after surgeries were retrieved from an electronic database search applying structured search strategies in PubMed, MEDLINE, Embase, CINAHL Plus and Cochrane Database of Systematic Reviews from inception to 31 December 2022. Two reviewers selected systematic reviews, extracted data regarding the definition, prevalence and risk factors of CPSP and PPOU and assessed the quality using the AMSTAR 2 tool. Results The study identified 6936 records related to chronic pain and persistent opioid use in patients after surgery, of which 24 articles were identified for full-text review. Eighteen systematic reviews were included in this umbrella review, of which five systematic reviews assessed chronic pain in patients who had undergone a surgical procedure, and 13 reviews assessed persistent opioid use after surgery. Despite considerable variations in patient characteristics (from age ≥18 years), types of surgeries, follow-up duration and the definitions of measures, most reviews were of medium to good quality (fulfilled 9-11/16 AMSTAR 2 criteria). The prevalence of CPSP and PPOU, commonly synthesised at 3, 6 or 12 months after surgeries, varied from 5%–58% and 2%–65%, respectively, despite various terminologies, definitions and timing of measures and associated determinants. The prevalence of neuropathic pain in CPSP was obtainable for four surgeries, with 9%–74%. Conclusion To inform future practice and policy to optimise pain management and opioid safety, consensus on standardising measurements and further studies assessing risk factors associated with CPSP, PPOU and adverse outcomes are needed.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prevalence and determinants of chronic pain and persistent opioid use after surgery: A review of systematic reviews

Bansal,

Ang,

Chen

2023

British Journal of Pain

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Stakeholder Perspective on Opioid Stewardship After Prostatectomy: Evaluating Barriers and Facilitators From the Pennsylvania Urology Regional Collaborative

Lee

Talwar

Ding

et al. 2020

Urology

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Preoperative Opioid Dose and Surgical Outcomes in Colorectal Surgery

Zhang

Canner

et al. 2022

Journal of the American College of Surgeons

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BACKGROUND: The worsening opioid epidemic has led to an increased number of surgical patients with chronic preoperative opioid use. However, the impact of opioids on perioperative outcomes has yet to be fully elucidated. The purpose of this study was to assess the association between preoperative opioid dose and surgical outcomes among colectomy patients. METHODS: Adult colectomy patients in the IBM MarketScan database (2010–2017) were stratified based on preoperative opioid dose, calculated as the average opioid dose in morphine milligram equivalents (MME) in the 90 days prior to surgery: 0 MME, 1 to 49 MME, and 50 or more MME. The association between preoperative opioid dose and anastomotic leak, the primary outcome of interest, as well as other postoperative complications, was assessed using multivariable regression. RESULTS: Among 45,515 adult colectomy patients, 71.4% did not use opioids (0 MME), 27.4% had an opioid dose between 1 and 49 MME, and 1.2% had an opioid dose at or above 50 MME. Patients with preoperative opioid use exhibited a higher incidence of anastomotic leak (0 MME: 4.8%, 1–49 MME: 5.5%, ≥50 MME: 8.3%; p trend = 0.001). Multivariable analysis demonstrated a dose–response relationship between preoperative opioids and surgical outcomes, as the odds of anastomotic leak worsened with increasing opioid dose (1–49 MME: OR 1.19, 95% CI 1.08–1.31, p < 0.001; ≥50 MME: OR 1.64, 95% CI 1.20–2.24, p = 0.002). Similar dose–response relationships were seen after risk-adjustment for lung complications, pneumonia, delirium, and 30-day readmission (p < 0.05 for all). CONCLUSIONS: Providers should exercise caution when prescribing opioids preoperatively, as increasing doses of preoperative opioids were associated with worse surgical outcomes and higher 30-day readmission among adult colectomy patients.

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Post-surgical opioid prescribing patterns and risk factors for additional opioid prescriptions within one year after non-emergent colorectal surgery

Cited by 3 publications

References 24 publications

Prevalence and determinants of chronic pain and persistent opioid use after surgery: A review of systematic reviews

Prevalence and determinants of chronic pain and persistent opioid use after surgery: A review of systematic reviews

Stakeholder Perspective on Opioid Stewardship After Prostatectomy: Evaluating Barriers and Facilitators From the Pennsylvania Urology Regional Collaborative

Preoperative Opioid Dose and Surgical Outcomes in Colorectal Surgery

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