Comparative analysis of postoperative outcomes following hysterectomy versus sacrocolpopexy: Insights from global federated health research network☆

Dyadic associations between relationship quality and risk of opioid use among couples receiving methadone for opioid use disorder

Carpal tunnel release (CTR) is one of the most common hand surgeries. Studies have highlighted a mental-physical connection to hand pathologies and psychological connections to postoperative pain burden. Post-traumatic stress disorder (PTSD) has been identified as a medical-psychological comorbidity like other mental health disorders such as generalized anxiety disorder (GAD). There remains a gap in the literature regarding PTSD as a comorbidity for hand surgeries, where there is this mental-physical connection. We hypothesize PTSD will be associated with increased risk of postoperative pain, evidenced by greater prevalence of opioid usage. The authors performed a retrospective analysis using the TriNetX Research Database. Patients who underwent elective CTR were identified within the database. Two groups were created and compared against individual controls: the first was identified based on the diagnosis of PTSD, and the second was identified based on the diagnosis of GAD. Cohorts were matched and opioid usage was compared postoperatively. Patients with PTSD who underwent CTR were found to be at significantly increased risk of postoperative opioid use (P = .033) and more likely to present to the emergency department (ED) (P = .001). Patients with GAD were found to be significantly less likely to require postoperative opioids (P = .040). We found patients with PTSD to be at increased risk of opioid use and more likely to present to ED following CTR. Patients with GAD were found to be at decreased risk of opioid use after CTR. Owing to the independent significant risks not found in GAD, further research of postoperative pain in patients with PTSD is needed.

Dentists have contributed greatly to the opioid epidemic, dispensing roughly 8.6% of opioids totaling over 18 million prescriptions in a 12-month period from July 2016 to June 2017 and report educational gaps regarding screening techniques for substance misuse and an unfamiliarity with available referral resources. The purpose of this study was to determine the knowledge and comfort level of residents in identifying, referring, and managing patients who are at risk for opioid use or substance use disorder in the dental setting before and after an online case-based training course. Thirty-five first year (PGY1) and 11 second year (PGY2) advanced education in general dentistry (AEGD) residents participated in an online training course that aimed to assess knowledge in the domains of identifying, referring, and managing patients at risk for substance abuse disorder and opioid use in an academic setting. There were nine subdomains within the three major domains that further assessed resident comfort and knowledge. Before and after training, data were collected and analyzed. Analysis of the results indicated that (1) the training modules increased resident comfort in identifying (p=0.011), referring (p=0.032), and managing (p=0.002) patients at risk for opioid substance use. (2) PGY1 residents benefited more than PGY2 residents in identifying (p=0.034) and the manage domains (p<0.001). (3) Residents viewed the module quality, usefulness, and applicability favorably. Further analysis of the nine subdomains is presented. Our study suggests that dental curricula would benefit from incorporating training of residents in identifying, referring, and managing patients at risk for substance use disorder and opioid use.

To assess whether the risk of persistent opioid use after surgery varies by payer type. Persistent opioid use is associated with increased health care utilization and risk of opioid use disorder, opioid overdose, and mortality. Most research assessing the risk of persistent opioid use has focused on privately insured patients. Whether this risk varies by payer type is poorly understood. This cross-sectional analysis of the Michigan Surgical Quality Collaborative database examined adults aged 18 to 64 years undergoing surgical procedures across 70 hospitals between January 1, 2017 and October 31, 2019. The primary outcome was persistent opioid use, defined a priori as 1+ opioid prescription fulfillment at (1) an additional opioid prescription fulfillment after an initial postoperative fulfillment in the perioperative period or at least 1 fulfillment in the 4 to 90 days after discharge and (2) at least 1 opioid prescription fulfillment in the 91 to 180 days after discharge. The association between this outcome and payer type was evaluated using logistic regression, adjusting for patient and procedure characteristics. Among 40,071 patients included, the mean age was 45.3 years (SD 12.3), 24,853 (62%) were female, 9430 (23.5%) were Medicaid-insured, 26,760 (66.8%) were privately insured, and 3889 (9.7%) were covered by other payer types. The rate of POU was 11.5% and 5.6% for Medicaid-insured and privately insured patients, respectively (average marginal effect for Medicaid: 2.9% (95% CI 2.3%-3.6%)). Persistent opioid use remains common among individuals undergoing surgery and higher among patients with Medicaid insurance. Strategies to optimize postoperative recovery should focus on adequate pain management for all patients and consider tailored pathways for those at risk.

MP34-14 PERIOPERATIVE TRENDS AND RISK FACTORS FOR PERSISTENT OPIOID USE AFTER ENDOSCOPIC STONE SURGERY

ObjectiveWe assessed whether late versus early initiation of physical therapy (PT) was related to greater risk of future opioid use in people with knee osteoarthritis (OA) who receive PT.MethodsWe used...

Category:Ankle; HindfootIntroduction/Purpose:Past studies have found that preoperative chronic opioid therapy correlates with increased opioid use post-operatively as well as potentially worse surgical outcomes; however, these trends have not been extensively studied in cases of hindfoot fusions or ankle replacement (TAA). Therefore, we aimed to fill this gap in the research and understand the relationship between preoperative opioid use and postoperative success in order to improve patient outcomes. We hypothesized that patients with chronic opioid use prior to surgery would have increased likelihood of postoperative opioid use, complications, and re-operation.Methods:A retrospective review was conducted of ankle (AA), talo-navicular (TN), and tibio-talo-calcaneal (TTC) fusions, as well as TAAs from December 2014-August 2020 by a single fellowship trained foot and ankle surgeon. Pre- and postoperative opioid and other analgesic use, medical history, demographics, and surgical outcomes were reviewed. Statistical analysis was preformed using correlation, linear multivariate regression, independent-samples t-test, and one-way ANOVA. One-hundred and fifty-two patients (female=66, male=86) with mean BMI of 31.7 and mean follow-up of 1.35 years were included. Thirty-nine underwent isolated AA, 28 TTC, 85 TAA, 9 TAA + other hindfoot fusions, 1 pan-talar fusion, and 1 TN + ankle fusion. Seventeen had a history of substance abuse (i.e., EtOH, opioids, benzodiazepines, other substances). Records of preoperative opioid use were limited to 93 patients, 90-day postoperative opioid use to 81 patients, and 120-day postoperative opioid use to 73 patients.Results:Preoperative opioid use was significantly associated with reoperation rate (P=.027) and continued postoperative opioid use at 90 (P<.001) and 120 days (P<.001). Preoperative benzodiazepine use was significantly associated with continued postoperative benzodiazepine use at 90 (P<.001) and 120 days (P<.001). There was no significant difference in postoperative opioid use, complications, or reoperation rate between substance abusers and other patients. Female sex (P=.029) and BMI (P=.013) were significant predictors of postoperative opioid use. Of comorbidities, mental illness was a significant predictor of postoperative opioid use (P=.022); substance abuse history (P=.006) and mental illness (P=.001) were significant predictors of postoperative benzodiazepine use. In addition, postoperative opioid use significantly differed by surgery type (fusion=64.5 MME, TAA=28.0 MME, TAA + fusion=859.6 MME; P<.001), but postoperative benzodiazepine use did not.Conclusion:We found that patients with pre-operative opioid use have statically significantly higher rates of re-operation and continued post-operative opioid use. We also found that on average, patients undergoing hindfoot fusion require statically significantly more narcotics than those undergoing total ankle arthroplasty. Patients and surgeons should be aware of this data to help appropriately council patients on post-operative expectations.

Aim: To evaluate impact of co-morbidities on opioid use in endometriosis. Patients & methods: This was a retrospective analysis of data obtained from the Symphony Health database (July 2015-June 2018), which contains medical and pharmacy claims information on 79,947 women with endometriosis. Relative risk (RR) of postdiagnosis opioid use and supply duration associated with baseline co-morbidities were determined. Results: Women with endometriosis using opioids at baseline were 61% more likely to receive opioids postdiagnosis (RR: 1.61; 95% CI: 1.59-1.63). Risk of prolonged opioid supply postdiagnosis was highest for those with prolonged supply at baseline (RR: 21.14; 20.14-22.19), and was 1.32 (1.26-1.38) for patients with ≥1 co-morbidity, 1.37 (1.31-1.43) for pain co-morbidities and 1.07 (1.04-1.11) for psychiatric co-morbidities. Conclusion: Risk of opioid use after endometriosis diagnosis was greater in patients who used opioids before diagnosis. Risk of prolonged opioid use was greater if co-morbidities existed before diagnosis.

ABSTRACTBackgroundThis study evaluates the risk of persistent opioid use (POU) among thyroidectomy patients given postoperative opioids.MethodsPatients undergoing thyroidectomy were identified using the TriNetX Research Platform (2010–2024). Cohorts were divided based on opioid prescriptions on the day of surgery. With propensity score matching to prevent confounding bias, risk ratios were calculated for opioid prescriptions 3–9 months post‐surgery. Secondary outcomes included ED presentation, pain diagnosis, and lifetime risk of opioid use disorder, defined as significant social dysfunction due to uncontrolled use.ResultsThe post‐match opioid group (n = 19,727) experienced a 4.61% risk of POU (control: 4.07%), representing a 14% higher risk of POU compared to the non‐opioid group (RR 1.14, 95% CI: [1.03, 1.25]). Opioids slightly decreased the likelihood of outpatient visits at 30 days (RR: 0.97 [0.95, 0.98]) and 90 days (RR: 0.96 [0.94, 0.97]) following surgery. There were no significant differences in ED presentation, pain diagnoses at 30 and 90 days, or lifetime OUD risk.ConclusionPost‐thyroidectomy opioid prescription modestly increases POU risk, highlighting the need for careful patient counseling and judicious use.

Opioid use, postoperative complications, and implant survival after unicompartmental versus total knee replacement: a population-based network study.

Physicians, policymakers, and researchers are increasingly focused on finding ways to decrease opioid use and overdose in the United States both of which have sharply increased over the past decade. While many efforts are focused on the management of chronic pain, the use of opioids in surgical patients presents a particularly challenging problem requiring clinicians to balance 2 competing interests: managing acute pain in the immediate postoperative period and minimizing the risks of persistent opioid use after the surgery. Finding ways to minimize this risk is particularly salient in light of a growing literature suggesting that postsurgical patients are at increased risk for chronic opioid use. The perioperative care team, including surgeons and anesthesiologists, is poised to develop clinical- and systems-based interventions aimed at providing pain relief in the immediate postoperative period while also reducing the risks of opioid use longer term. In this paper, we discuss the consequences of chronic opioid use after surgery and present an analysis of the extent to which surgery has been associated with chronic opioid use. We follow with a discussion of the risk factors that are associated with chronic opioid use after surgery and proceed with an analysis of the extent to which opioid-sparing perioperative interventions (eg, nerve blockade) have been shown to reduce the risk of chronic opioid use after surgery. We then conclude with a discussion of future research directions.

155. What are the risk factors for continued opioid use in patients following spine surgery?

ABSTRACTBackgroundChronic opioid use is a common and serious consequence of hip fracture. We examined the association between socioeconomic position (SEP) and chronic opioid use after hip fracture surgery.MethodsUsing nationwide Danish registries, we included patients aged ≥ 65 years undergoing hip fracture surgery in 2012–2021 (n = 52,801). Cohabitation, liquid assets, and education were markers of SEP. Chronic opioid use was defined as ≥ 2 prescriptions of opioids 31–365 days post‐surgery. For the same period, all opioid doses were converted to morphine milligram equivalents (MME), mg/day. We used log‐binomial regression to estimate adjusted risk ratios (aRR) with 95%‐confidence intervals (CI) comparing patients within each SEP marker, adjusting for relevant confounding.ResultsThe 1‐year risks of chronic opioid use were 33% for patients living alone versus 30% for patients cohabiting (aRR 1.05 [CI 1.02–1.09]), 37% for low versus 28% for high levels of liquid assets (aRR 1.28 [CI 1.23–1.34]), and 33% for low versus 28% for high education (aRR 1.19 [CI 1.14–1.25]). Patients living alone used 11.5 MME mg/day versus 9.8 mg/day in patients cohabiting, patients with low liquid assets used 14.8 versus 7.9 mg/day in patients with high liquid assets, and patients with low education used 11.8 versus 7.9 mg/day in patients with high education.ConclusionsAbout a third of hip fracture patients are using opioids continuously in the year after surgery. Living alone, less liquid assets, and low education were associated with a higher risk of opioid use and dosage of use, both in preoperative opioid users and non‐users.Significance StatementThis study shows that among patients undergoing hip fracture surgery, low socioeconomic position measured by living alone, having less liquid assets or low education is associated with a higher risk of chronic opioid use and higher dosage of use in the first year postoperatively. Clinicians should consider socioeconomic position when prescribing opioids after hip fracture. The integration of less addictive opioids and non‐pharmacological approaches in the pain management may reduce opioid use and improve patient safety.

Eliminating postoperative opioid prescriptions is associated with lower long term opioid use (523)

BackgroundCharacterizing the impacts of postoperative opioid use on total knee arthroplasty (TKA) patients may help optimize the pain management after TKA. The aim of the study is to examine the prevalence and risk factors for opioid use with an enhanced-recovery programme after primary TKA.MethodsWe identified 361 patients undergoing TKA, and separated those on the basis of whether to receive opioid use after surgery. Themultivariate logistic regression model was used to identify independent risk factors for opioid use after primary TKA. Length of stay (LOS) and postoperative complications were also recorded and compared.ResultsThe prevalence of opioid use after primary TKA was 23.0%. The significant risk factor was the longer operative time (OR [odds ratio] = 1.017, 95% CI [confidence interval] = 1.001 to 1.032, p = 0.034) and the protective factor was the utilization of tranexamic acid(OR= 0.355, 95% CI = 0.161 to 0.780, p = 0.010). In addition, the LOS was longer in opioid group (p < 0.05).ConclusionConsidering the adverse health effects of opioid use, strategies need to be developed to prevent persistent opioid use after TKA. Reducing operative time and the application of tranexamic acid could lower the risk of opioid use with an enhanced-recovery programme after primary TKA.