Opioid use prior to elective surgery is strongly associated with persistent use following surgery: an analysis of 14 354 Medicare patients.
Administration, Oral
Adult
Aged
Analgesics, Opioid
/ administration & dosage
Arthroplasty, Replacement
/ adverse effects
Case-Control Studies
Elective Surgical Procedures
/ adverse effects
Female
Humans
Male
Medicare
/ statistics & numerical data
Middle Aged
Morphine
/ administration & dosage
Opioid-Related Disorders
/ epidemiology
Pain, Postoperative
/ drug therapy
Perioperative Care
/ statistics & numerical data
Primary Health Care
/ ethics
Retrospective Studies
Risk Reduction Behavior
United States
/ epidemiology
general surgery
orthopaedic surgery
urology
Journal
ANZ journal of surgery
ISSN: 1445-2197
Titre abrégé: ANZ J Surg
Pays: Australia
ID NLM: 101086634
Informations de publication
Date de publication:
11 2019
11 2019
Historique:
received:
27
06
2019
revised:
13
09
2019
accepted:
14
09
2019
pubmed:
23
10
2019
medline:
2
10
2020
entrez:
23
10
2019
Statut:
ppublish
Résumé
Persistent opioid use following total joint replacement (TJR) surgery is common; however, the association between pre-surgical opioid use and surgery type has not been established. The objective of this study was to determine the association between pre-surgery opioid use and persistent post-surgery opioid use in TJR patients compared to other elective surgical patients. This is a retrospective cohort study, of univariate and multinomial logistic regression of linked, de-identified Medicare Benefits Schedule and Pharmaceutical Benefits Schedule data, adjusted for perioperative opioid use, age and sex. Oral morphine equivalents daily doses (OMEDD) were calculated and opioid use was categorized into three mutually exclusive categories for each observation window: low (0-5 OMEDD), moderate (5-10 OMEDD), high (10+ OMEDD). Persistent opioid use was defined as opioid use between 180 and 270 days after the date of surgery. Persistent opioid use was associated with older age, female gender and pre-surgery opioid use. There was no increased risk for persistent opioid use for TJR patients compared to other surgical patients. The intensity of pre-surgery opioid usage is strongly associated with persistent opioid use in all observed surgical patients. Our results suggest that many patients who use opioids prior to surgery will persist in their opioid use following surgery. No association was found between persistent opioid use and TJR surgery, but rather a risk reduction compared to other elective surgeries when associations with opioid use are controlled for. Primary care clinicians and surgeons should monitor the duration and dosage of perioperative opioid use.
Sections du résumé
BACKGROUND
Persistent opioid use following total joint replacement (TJR) surgery is common; however, the association between pre-surgical opioid use and surgery type has not been established. The objective of this study was to determine the association between pre-surgery opioid use and persistent post-surgery opioid use in TJR patients compared to other elective surgical patients.
METHODS
This is a retrospective cohort study, of univariate and multinomial logistic regression of linked, de-identified Medicare Benefits Schedule and Pharmaceutical Benefits Schedule data, adjusted for perioperative opioid use, age and sex. Oral morphine equivalents daily doses (OMEDD) were calculated and opioid use was categorized into three mutually exclusive categories for each observation window: low (0-5 OMEDD), moderate (5-10 OMEDD), high (10+ OMEDD). Persistent opioid use was defined as opioid use between 180 and 270 days after the date of surgery.
RESULTS
Persistent opioid use was associated with older age, female gender and pre-surgery opioid use. There was no increased risk for persistent opioid use for TJR patients compared to other surgical patients. The intensity of pre-surgery opioid usage is strongly associated with persistent opioid use in all observed surgical patients.
CONCLUSIONS
Our results suggest that many patients who use opioids prior to surgery will persist in their opioid use following surgery. No association was found between persistent opioid use and TJR surgery, but rather a risk reduction compared to other elective surgeries when associations with opioid use are controlled for. Primary care clinicians and surgeons should monitor the duration and dosage of perioperative opioid use.
Identifiants
pubmed: 31637832
doi: 10.1111/ans.15492
pmc: PMC6900005
doi:
Substances chimiques
Analgesics, Opioid
0
Morphine
76I7G6D29C
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1410-1416Subventions
Organisme : NHMRC Centre for Research Excellence in Total Joint Replacement OPtimising oUtcomes, equity, cost effectiveness and patient Selection (OPUS)
ID : APP1116325
Pays : International
Organisme : NHMRC Practitioner Fellowship
ID : APP1154203
Pays : International
Organisme : NHMRC Career Development Fellowship
ID : APP1122526
Pays : International
Organisme : Centre of Excellence in Population Ageing Research, Australian Research Council (CEPAR)
ID : CE170100005
Pays : International
Informations de copyright
© 2019 The Authors ANZ Journal of Surgery published by John Wiley & Sons Australia, Ltd on behalf of Royal Australasian College of Surgeons.
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