(273) Acute Postoperative Opioid Trajectories and Long-Term Outcomes in Pediatric Patients after Surgery

Abstract

The days following surgery encompass a critical period where the use of opioids predicts long-term outcomes in adults. It is currently unknown as to whether opioid consumption throughout the acute postoperative period is associated with long-term outcomes in pediatric patients. The aims of this study were to characterize opioid trajectories in the acute postoperative period, identify predictors of opioid trajectory membership and determine associations between opioid trajectories and long-term patient outcomes. Medication use, pain and mental health status were assessed at baseline in adolescents with idiopathic scoliosis who were schedule for spinal fusion surgery. Cumulative 6-hour opioid consumption was recorded for up to 5 days after spinal surgery. At 6 weeks and 6 months after surgery, medication use, pain and physical function were evaluated. Growth mixture modeling was used to identify opioid trajectories. The study included 106 patients. Mean cumulative opioid consumption in the acute postoperative period was 13.23 ± 5.20 mg/kg. The model with the best fit contained 5 acute postoperative opioid trajectories and a quadratic term (AIC = 6703.26, BIC = 6767.19). Opioid trajectories differed in the total amount of opioids consumed and the rate of opioid intake over the acute postoperative period. Intraoperative epimorphine dose predicted the opioid trajectory membership (p = 0.0498). Opioid trajectory groups were significantly associated with pain at 6 weeks (p = 0.0103) and 6 months (p = 0.0457) after surgery. Intraoperative epimorphine dose predicts the opioid consumption in the acute postoperative period. Opioid consumption during this period is associated with long-term pain. Understanding the acute postoperative period and its association with baseline predictors and long-term patient outcomes will allow for personalized perioperative care.