OPEN examines data, clinical practices and strategies to support better pain management, opioid stewardship, policy, treatment and care.
- Prescription opioid use is common before and after liver transplant, with intermittent and chronic use largely persisting, and a small development of new chronic use posttransplant.
- Among previously opioid-naïve patients, 4% developed chronic use posttransplant.
- Among patients with pretransplant opioid use, 84% remained intermittent or increased to chronic use, and 73% of chronic users remained chronic users after transplant.
- To minimize the morbidity of long-term opioid use, it is critical to improve pain management and optimize opioid use before and after liver transplant.
- Preoperative opioid use was correlated with an increased mortality within 90 days after surgery
- Patients with high and medium preoperative opioid exposure were more likely to die within 90 days after outpatient surgery compared with opioid-naïve patients
- Mortality did not differ between opioid-naïve patients and patients with low preoperative opioid exposure.
- Among the Medicare patient population who undergo elective surgery, 55% were opioid naïve while the remaining 45% filled one or more opioid prescriptions in the 12 months before surgery.
- Patients were grouped into five levels of preoperative opioid exposure – naïve, minimal, low, moderate, and high/chronic.
- Higher levels of preoperative opioid exposure were associated with higher rates of opioid-related readmissions, pain-related readmissions, respiratory-related readmissions, and all-cause readmissions.
- 41% of patients had nonchronic, periodic opioid fills in the year prior to general, gynecologic, and urologic surgical procedures.
- Patterns of preoperative fills were most strongly associated with persistent postoperative opioid use. Patients with recent intermittent use were significantly more likely to have prolonged fills after surgery compared with opioid-naïve patients
- Identifying opioid use before surgery is a critical opportunity to optimize care after surgery.
- 6% of patients are prescribed a gabapentinoid prior to surgery
- Of the patients with preoperative gabapentinoid use, 24% had prolonged gabapentinoid use and 20% of the preoperative gabapentinoid users also filled opioid prescriptions at 91 to 180 days after carpal tunnel release
- Given the effectiveness of surgical release and the risks associated with gabapentinoids, greater attention is needed to ensure that gabapentinoids are prescribed appropriately, avoided when possible, and stopped after surgery.
- Preoperative opioid use is common among patients who undergo elective surgery, with 38% filling an opioid prescription in the 12 months before surgery.
- Even minimal opioid use before surgery increases the probability of needing additional postoperative prescriptions in the 30 days after surgery.
- Surgeons should take into account any preoperative opioid use in patients when prescribing and coordinating postoperative pain management.
The Effect of Preoperative Opioid Use on Healthcare Utilization and Expenditures Following Elective Abdominal SurgeryWaljee JF, Cron DC, Steiger RM, Zhong L, Englesbe MJ, Brummett CM. Effect of Preoperative Opioid Exposure on Healthcare Utilization and Expenditures Following Elective Abdominal Surgery. Ann Surg. 2017;265(4):715-721. doi:10.1097/SLA.0000000000002117
- Preoperative opioid use is an independent risk factor for longer hospital stays, higher 30-day readmission rates, higher probability of being discharged to a rehabilitation facility, and greater healthcare expenses in the postoperative period.
- Identifying strategies to minimize opioid consumption prior to surgery will aid in reducing patient risk, improving outcomes, and lowering healthcare costs.
Preoperative Opioid Use is Independently Associated with Increased Costs and Worse Outcomes After Major Abdominal SurgeryCron DC, Englesbe MJ, Bolton CJ, et al. Preoperative Opioid Use is Independently Associated With Increased Costs and Worse Outcomes After Major Abdominal Surgery. Ann Surg. 2017;265(4):695-701. doi:10.1097/SLA.0000000000001901
- The study considered patients at a single center having abdominopelvic surgeries (appendectomy, cholecystectomy, gynecologic and bowel procedures, etc.) and found that patients using opioids preoperatively had 9.2% higher costs.
- Patients with preoperative opioid use had longer length of stay at the hospital, more complications and more readmissions, indicating that preoperative opioid use is a modifiable risk factor for surgery.