Assessment of laparotomy-induced stress response in opium- and morphine-addicted rats by measuring serum glucose and corticosterone levels: an animal experiment.

P121. Chronic opioid use following anterior cervical discectomy and fusion surgery for degenerative cervical pathology

Objective Chronic opioid use presents long-term health risks for individuals with spinal cord injury (SCI). The purpose of the study was to characterize patterns and correlates of the chronic prescription of opioids among individuals with SCI in a population of Veterans receiving care though the Veteran’s Health Administration. Design A retrospective, longitudinal cohort study examined the US Department of Veterans Affairs electronic medical record data of veterans with SCI. The annual prevalence of prescription opioid use by type (any, acute, chronic, incident chronic) was calculated for each study year (2015–2017). Multivariable models examined associations with demographics and pre-existing medical comorbidities. Setting US Department of Veterans Affairs, Veteran’s Health Administration. Participants National sample of Veterans with SCI (N = 10,811). Main Outcome Measure Chronic prescription opioid use (≥90 days). Results All types of prescription opioid use declined across the three study years (chronic opioid use prevalence = 33.2%, 31.7%, and 29.7%, respectively). Past history of depression, COPD, diabetes, pain condition, opioid use and tobacco use disorders were associated with a greater likelihood of current chronic prescription opioid use. Non-white race, hyperlipidemia, dementia, and tetraplegia were associated with a lower likelihood of current chronic prescription opioid use. When added to the multivariable model, prior chronic opioid prescription use was robustly associated with current chronic prescription opioid use, but most other factors were no longer significantly associated with current opioid use. Conclusions This study demonstrates opioid reduction over time from 2015 to 2017, however, chronic prescription opioid use remains common among a substantial minority of Veterans with SCI. Several demographics and comorbidities may provide clinicians with important insights into factors associated with chronic prescription opioid use, with past chronic prescription opioid use being the most important.

181. Is patient geography a risk factor for chronic opioid use after ACDF?

15. Impact of chronic preoperative opioid use on complications in elderly undergoing anterior cervical discectomy and fusion

This study investigates Enhanced Recovery After Surgery (ERAS) protocols' impact on long-term opioid and sedative use following mastectomy with or without implant-based breast reconstruction (IBBR). ERAS protocols for patients undergoing mastectomy with or without IBBR are associated with decreased length of stay, increased rate of same-day discharge, decreased postoperative pain, and decreased postoperative opioid requirements. However, less is known about their effect on opioid and sedative use beyond 90 days after surgery. A retrospective review of all patients undergoing mastectomy with or without IBBR at a single institution between January 2013 and December 2019. Mastectomy ERAS protocols were implemented in February 2017, creating 2 groups: pre-ERAS and ERAS. Baseline characteristics and prevalence of chronic opioid and sedative use were compared. Univariable and multivariable logistic regression predicted factors associated with increased odds of chronic opioid and sedative use. A total of 756 patients were evaluated: 405 pre-ERAS and 351 ERAS. Post-ERAS, chronic opioid use decreased in opioid-naive (40% vs 30%, P =0.024) and opioid-tolerant patients (58% vs 37%, P =0.002), with no increase in chronic sedative use. There were decreased odds of chronic opioid use for all ERAS patients (OR=0.57, 95% CI: 0.42-0.76), and of IBBR patients, those receiving subcutaneous implants (OR=0.31, 95% CI: 0.20-0.48). There was increased chronic opioid-use odds if undergoing bilateral surgery (OR=1.54, 95% CI: 1.14-2.08), 2-stage reconstruction (OR=9.78, 95% CI: 5.94-16.09), and for patients with higher PACU pain scores (OR=1.09, 95% CI: 1.03-1.14) or >150 discharge OMEs (OR=2.63, 95% CI: 1.48-4.68). ERAS protocols for mastectomy patients with or without IBR are associated with decreases in chronic opioid use, without concomitant increases in chronic sedative use.

Chronic opioid use following anterior cervical discectomy and fusion surgery for degenerative cervical pathology

There are a number of studies in the literature that describe the prevalence, causes, and factors associated with chronic postoperative opioid use, but there is a lack of synthesis of the literature to guide clinicians in optimally managing postoperative pain while avoiding opioid dependence. Thus, the goal of this study was to perform a systematic review of the literature to investigate the prevalence of chronic postoperative opioid use and the associated risk factors. A systematic search was performed using Ovid Medline and Embase according to PRISMA guidelines. Data were collected on the following outcomes of interest: prevalence of opioid use at 3, 6, and 12months postoperatively, and risk factors associated with chronic postoperative opioid use. Forty-three articles were included in the final analysis. The mean prevalence of chronic postoperative opioid use in all populations at 3, 6, and 12months postoperatively was 30.5%, 25.6%, and 25.2%, respectively. The prevalence of patients who developed chronic opioid use at 3, 6, and 12months postoperatively was 10.4%, 8.5%, and 9.8%, respectively. Forty of the articles analyzed risk factors associated with chronic postoperative opioid use. The most common associated risk factor identified was preoperative opioid use with 27 articles demonstrating a significant association with chronic postoperative opioid use. The current opioid crisis is in part secondary to the prevalence of chronic opioid use following surgery. This study identified associated risk factors with chronic postoperative opioid use, which may help identify patients at risk for developing chronic postoperative opioid use.

Chronic opioid use is a significant public health concern. Surgery is a risk factor for developing chronic opioid use. Patients undergoing major spine surgery frequently are prescribed opioids preoperatively and may be at risk for chronic opioid use postoperatively. The aim of this study was to investigate the incidence of and perioperative risk factors associated with chronic opioid use after major spine surgery. The records of patients who underwent elective major spine surgery at the University of Virginia between March 2011 and February 2016 were retrospectively reviewed. The primary outcome was chronic opioid use through 12 months postoperatively. Demographic data, medical comorbidities, preoperative pain scores, and medication use including daily morphine-equivalent (ME) dose, intraoperative use of lidocaine and ketamine, estimated blood loss, postoperative pain scores and medication use, and postoperative opioid use were collected. Logistic regression models were used to examine factors associated with chronic opioid use. Of 1477 patient records reviewed, 412 patients (27.9%) were opioid naive and 1065 patients (72.3%) used opioids before surgery. Opioid data were available for 1325 patients, while 152 patients were lost to 12-month follow-up and were excluded. Of 958 preoperative opioid users, 498 (52.0%) remained chronic users through 12 months. There was a decrease in opioid dosage (mg ME) from preoperative to 12 months postoperatively with a mean difference of -14.7 mg ME (standard deviation, 1.57; 95% confidence interval [CI], -17.8 to -11.7). Among 367 previously opioid-naive patients, 67 (18.3%) became chronic opioid users. Factors associated with chronic opioid use were examined using logistic regression models. Preoperative opioid users were nearly 4 times more likely to be chronic opioid users through 12 months than were opioid-naive patients (odds ratio, 3.95; 95% CI, 2.51-6.33; P < .001). Mean postoperative pain score (0-10) was associated with increased odds of chronic opioid use (odds ratio for a 1 unit increase in pain score 1.25, 95% CI, 1.13-1.38; P < .001). Use of intravenous ketamine or lidocaine was not associated with chronic opioid use through 12 months. Greater than 70% of patients presenting for major spine surgery used opioids preoperatively. Preoperative opioid use and higher postoperative pain scores were associated with chronic opioid use through 12 months. Use of ketamine and lidocaine did not decrease the risk for chronic opioid use. Surveillance of patients for these factors may identify those at highest risk for chronic opioid use and target them for intervention and reduction strategies.

INTRODUCTION: Opioid and benzodiazepine use in cirrhotic patients is probably underestimated and results in a significant burden for both patients and the healthcare system. Recent epidemiologic studies reported an upward trend in the number of both prescriptions in this drug-sensitive patient population. This study therefore aimed to derive a robust prevalence estimate of chronic opioid and benzodiazepine use in patients with liver cirrhosis. METHODS: We performed a comprehensive literature search in PubMed, PubMed Central, Embase, and ScienceDirect databases from inception through May, 2019 to identify all studies that evaluated the prevalence of either chronic opioid use or benzodiazepine use in patients diagnosed with cirrhosis. We included studies that presented event rates with a 95% confidence interval (CI) or presented the data sufficient to calculate the event rate with a 95% CI. Although the definition of chronic opioid use varied between the involved studies, more than 60 days of either opioid or benzodiazepine use per annum was considered ‘chronic’ in this meta-analysis. Statistical analysis was performed using the Comprehensive Meta-Analysis (CMA), Version 3 software. RESULTS: Seven studies with a total of 300472 patients with liver cirrhosis were included in the analysis of chronic opioid use with a pooled event rate of 34.7% (95% CI: 0.239 – 0.473) and a reported prevalence range of 22.3-64.7% among the included studies. (Figure 1) On the other hand, six studies with a total of 173127 patients with liver cirrhosis were included in the analysis of chronic benzodiazepine use with a pooled event rate of 15.9% (95% CI: 0.079 - 0.294) and a reported prevalence range of 7.9-37.1%. (Figure 2) CONCLUSION: Our results indicate that chronic opioid and benzodiazepine use are prevalent among patients with liver cirrhosis. This is clinically important as their use was shown to be associated with increased readmission rates, hepatic decompensation, and all-cause mortality. Physicians should be cognizant of the implications of prescribing these medications and consider pursuing other pharmacological and non-pharmacological forms of analgesia in this patient population.

Risk Factors for Chronic Prescription Opioid Use in Multiple Sclerosis

Physiological state is an emergent property of the interactions among physiological systems within an intricate network. Understanding the connections within this network is one of the goals in physiological ecology. Here, we studied the relationship between body condition, two neuroendocrine hormones (corticosterone and insulin-like growth factor 1 [IGF-1]) as physiological regulators, and two physiological systems related to resource metabolism (glucose) and oxidative balance (malondialdehyde). We measured these traits under baseline and stress-induced conditions in free-living house sparrows (Passer domesticus). We used path analysis to analyze different scenarios about the structure of the physiological network. Our data were most consistent with a model in which corticosterone was the major regulator under baseline conditions. This model shows that individuals in better condition have lower corticosterone levels; corticosterone and IGF-1 levels are positively associated; and oxidative damage is higher when levels of corticosterone, IGF-1, and glucose are elevated. After exposure to acute stress, these relationships were considerably reorganized. In response to acute stress, birds increased their corticosterone and glucose levels and decreased their IGF-1 levels. However, individuals in better condition increased their corticosterone levels more and better maintained their IGF-1 levels in response to acute stress. The acute stress-induced changes in corticosterone and IGF-1 levels were associated with an increase in glucose levels, which in turn was associated with a decrease in oxidative damage. We urge ecophysiologists to focus more on physiological networks, as the relationships between physiological traits are complex and dynamic during the organismal stress response.

Comparing different chronic preoperative opioid use definitions on outcomes after spine surgery

Trends in Opioid Utilization Before and After Total Knee Arthroplasty

253. Factors associated with chronic opioid use in preoperative opioid nonusers following adult spinal deformity surgery

Background and purposeOur aim was to study the association between chronic preoperative opioid use and 1-year revision rate, mortality, and patient-reported outcomes (PROs) after primary total knee and hip arthroplasty (TKA/THA). We also investigated whether age, sex, or BMI modified these associations.MethodsTKAs and THAs performed for osteoarthritis between 2013 and 2018, originating from the Dutch Arthroplasty Register, were linked to the Dutch Foundation for Pharmaceutical Statistics. Chronic preoperative opioid use was defined as > 1,800 morphine mg equivalent dispensed 1 year before surgery and ≥ 1 opioid prescribed 30 days before surgery. Outcomes were 1-year revision rate, mortality, self-reported physical functioning, pain, and quality of life (QoL). Incidence rates were calculated; Cox regression and linear mixed models were used. We assessed effect modification by assessment of supra-additive effects.ResultsPreoperative chronic opioid use occurred in 4.5% of 29,739 THAs and 3.4% of 27,873 TKAs. Chronic opioid use doubled mortality and revision rates for both TKAs and THAs (range of hazard ratios 1.7–2.1). The association of preoperative opioid use with 1-year revision rate was larger in males, in patients with a BMI ≤ 30 (THA) and > 30 (TKA), and 66–75-year-olds. Younger patients exhibited a more pronounced association between opioid use and reduced physical functioning and QoL, and increased pain. Sex and BMI had no modifying effects on PROs.ConclusionPreoperative chronic opioid use was associated with a higher likelihood of 1-year revision and mortality and worse PROs. The associations with revision risk were modified by age, sex, and BMI. Age also had a modifying effect on PROs.