Trajectories of opioid consumption from day of surgery to 28 days postoperatively: a prospective cohort study in patients undergoing abdominal, joint, or spine surgery

Abstract

IntroductionDescriptions of opioid use trajectories and their association with postsurgical pain and opioid consumption are limited. We hypothesized that trajectories of opioid consumption in the first 28 days following surgery would be associated with unique patterns of pain and duration of opioid use.MethodsA prospective longitudinal cohort of patients undergoing elective inpatient abdominal, joint, or spine surgery between June 2016 and June 2019 was studied. At hospital discharge and every 7 days for 28 days, patients were assessed for pain, analgesic use, pain interference, satisfaction, and side effects. Duration of opioid use was determined for 6 months. The primary analysis used latent class group modeling to identify trajectories of opioid use.ResultsDecreasing, high, and persistent opioid trajectories were identified following joint and spine surgery and a decreasing and persistent trajectory following abdominal surgery. Reported pain was greater in the high and persistent trajectories compared with the decreasing use trajectories. Compared with the decreasing opioid trajectory, the median duration of opioid use was increased by 4.5 (95% CI 1 to 22, p<0.01) weeks in persistent opioid use abdominal and by 6 (95% CI 0 to 6, p<0.01) weeks in the high or persistent use joint and spine groups. The odds (95% CI) of opioid use at 6 months in the high or persistent opioid use trajectory was 24.3 (2.9 to 203.4) for abdominal and 3.7 (1.9 to 7.0) for joint or spine surgery compared with the decreasing use trajectory. Morphine milliequivalent per 24 hours of hospitalization was the primary independent predictor of opioid use trajectories.ConclusionsWe observed distinct opioid use trajectories following abdominal and joint or spine surgery that were associated with different patterns of pain and duration of opioid use postoperatively. Prediction of postoperative opioid use trajectory groups may be clinically important for identifying risk of prolonged opioid use.

Multiorganizational consensus to define guiding principles for perioperative pain management in patients with chronic pain, preoperative opioid tolerance, or substance use disorder

“…For patients and clinicians finding opioid dose tapering to be challenging in the setting of preoperative opioid tolerance, consultation with pain medicine, behavioral health, or addiction medicine specialists should be used in lieu of persistent dose escalation and ongoing medication refills. The primary prescriber and surgical care team can collaborate to identify an aberrant trajectory of recovery and medication need 55…”

Survey Response Rates to a Self-Initiated Longitudinal Survey Accessed by a Quick Response Code in Six Different Regions of the United States

“…Our parents may have also been overwhelmed with caring for their child after surgery and having their other children at home during the coronavirus disease 2019 pandemic lockdown period and required remote learning. The use of a web-based survey accessible by a smartphone has been shown to produce lower response rates in patients over 75 years of age [ 12 ]. Our participants were all parents of children under 19 with the majority being in their third and fourth decades of life.…”

“…Other survey modalities have been associated with improved response rates. In a similar study that surveyed adult opioid use postoperatively after hospital discharge, patients were required to give informed, written consent prior to hospital discharge and were reached by phone calls on a weekly basis for four weeks [ 12 ]. A comparison in response rates reveals dramatically improved results.…”

Integrating mechanistic-based and classification-based concepts into perioperative pain management: an educational guide for acute pain physicians

“…A recent retrospective cohort analysis of insurance claims data comprizing over 57 000 patients did not find clinically significant differences in postsurgical opioid utilization in terms of prescriptions filled or dosages in MME/day regardless of whether patients had stable, increasing or decreasing trajectories of presurgical opioid utilization 131. However, numerous studies have found that intraoperative remifentanil use is associated with greater postsurgical opioid requirements and hyperalgesia,130 132 and a recent large prospective cohort study in over 1800 patients found that a stable or increasing trajectory of postsurgical opioid requirements within the first month after joint, spine or abdominal surgery was associated with a significantly greater likelihood of subsequent chronic opioid use (>6 months postsurgery) 133. These trends suggest that the reduction of perioperative opioid exposure and opioid requirements via multimodal analgesic strategies may reduce postsurgical opioid requirements and improve safety.…”