Postoperative duration of opioid use and acute healthcare services use in cancer patients hospitalized for thoracic surgery

Association Between Opioid-Related Mortality and History of Surgical Procedure: A Population-Based Case-Control Study

Objective

This study examined whether there is an association between opioid-related mortality and surgical procedures.

Methods

A case-control study design using deceased controls compared individuals with and without opioid death and their exposure to common surgeries in the preceding 4 years. This population-based study used linked death and hospitalization databases in Canada (excluding Quebec) from January 01, 2008 to December 31, 2017. Cases of opioid death were identified and matched to 5 controls who died of other causes by age (±4 years), sex, province of death, and date of death (±1 year). Patients with HIV infection and alcohol-related deaths were excluded from the control group. Logistic regression was used to determine if there was an association between having surgery and death from an opioid-related cause by estimating the crude and adjusted odds ratios (ORs) with the corresponding 95% confidence interval (CI). Covariates included sociodemographic characteristics, comorbidities, and the number of days of hospitalization in the previous 4 years.

Results

We identified 11,865 cases and matched them with 59,345 controls. About 11.2% of cases and 12.5% of controls had surgery in the 4 years before their death, corresponding to a crude OR of 0.89 (95% CI: 0.83-0.94). After adjustment, opioid mortality was associated with surgical procedure with OR of 1.26 (95% CI: 1.17-1.36).

Conclusions

After adjusting for comorbidities, patients with opioid mortality were more likely to undergo surgical intervention within 4 years before their death. Clinicians should enhance screening for opioid use and risk factors when considering postoperative opioid prescribing.

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

INTRODUCTION

Descriptions 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.

METHODS

A 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.

RESULTS

Decreasing, 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.

CONCLUSIONS

We 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.