(286) Chronic Opioid Use after Thoracic Surgery among VA Veterans

Abstract

The incidence of chronic pain following thoracic surgery (∼50%) is greater than most other surgeries. The goal of this retrospective study was to detect the incidence of prolonged opioid use at 1 year after surgery among those veterans who were chronic opioid users versus not chronic users during the one year prior to their thoracic surgery, separately. In addition, predictors of prolonged opioid use at 1 year after surgery from demographic, surgical, and comorbid medical and psychiatric factors were assessed for each of the two groups separately. Veterans Health Administration sample of 19,240 patients who had thoracotomy or video assisted thoracoscopy between 2006 and 2015 and were alive at one year after surgery were included. “Chronic opioid use” was defined as consistent opioid prescription for more than 90 days during the year (1). Veterans’ opioid use during the 1-year prior to surgery was used to determine whether they were “preoperative chronic opioid users” at the time of surgery. Similarly, the opioid use information during the first year after the surgery was used to determine whether they become “prolonged opioid users” during the 1-year following surgery. Out of 2,370 preoperative opioid users at the time of surgery, 61% (95% CI: 59% to 63%) continued prolonged opioid use at 1 year after their thoracic surgery. Only younger age and the presence of pre-existing chronic pain were associated with the prolonged opioid use at 1 year after surgery. Out of 16,870 patients who were not preoperative chronic opioid users during the year prior to their surgery, 6.8% (95% CI: 6.4% to 7.2%) became prolonged opioid users. At the 0.01 type I error level, the presence of pre-existing chronic pain, longer duration of hospital stay, antidepressant use and benzodiazepine use were associated with prolonged opioid use at one year after thoracic surgery.