Patient Factors Associated With High Opioid Consumption Following Common Surgical Procedures Following State Mandated Opioid Prescription Regulations
Autumn Sacklow, Ajai Malhotra, Ethan Jones, Peter Callas, Mayo Fujii, Christos Colovos
Department of Surgery , University of Vermont, Burlington, Vermont, United States
Objective: Previously we demonstrated that ~75% of individuals use <50% of prescribed opioids post-operatively (low use group), while 25% use >75% (high use group). This holds true irrespective of procedure magnitude, specialty and even after state mandated reduction in opioid prescriptions. The current study aims at identifying patient related factors that may predict the 'high use group".
Design: Observational cohort study comparing patient characteristic of low vs high opioid use post-operatively. Patients undergoing 44 common surgical procedures across seven specialties were phone surveyed one-week post-discharge for opioid use and adequacy of analgesia. Electronic medical records were queried for 1) demographics; 2) co-morbidities; 3) pre-operative medications including opioids; and 4) social factors.
Setting: 620-bed tertiary care academic medical center.
Patients: Consecutive patients undergoing 44 procedures across seven specialties (9/2017 - 2/2019).
Main Outcome Measures: Total post-operative opioid use in morphine milligram equivalents (MME). Patients were classified as high or low use analyzing the kernel density distribution for each procedure. Patient-centered factors associated with high use were identified by regression analysis.
Results: 1249 patients were enrolled (718 female/531 male). As in our previous studies, two distinct patient populations were observed: high-use consuming >75th percent (HighMME: n=257); and low-use consuming <50th percent (LowMME: n=992) of prescribed opioids. History of prior substance use (p<0.001), depression (p=0.003), anxiety disorders (p<0.001), asthma (p=0.006), obesity (p=0.03), migraine (p=0.004), opioid use in the 7 days prior to surgery (p<0.001) and increased post-operative use of non-opioid analgesics were associated with HighMME.
Conclusions: Specific pre-operative patient characteristics exist that can identify patients requiring high amounts of opioids post-operatively. Pre-operative intervention programs should be evaluated for this high use group to mitigate against persistent opioid use disorder.
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