Abstract
Objectives. Patients taking opioids prior to surgery experience prolonged postoperative opioid use, worse clinical outcomes, increased pain, and more postoperative complications. We aimed to compare preoperative opioid users to their opioid naïve counterparts to identify differences in baseline characteristics. Methods. 107 patients presenting for thoracotomy, total knee replacement, total hip replacement, radical mastectomy, and lumpectomy were investigated in a cross-sectional study to characterize the associations between measures of pain, substance use, abuse, addiction, sleep, and psychological measures (depressive symptoms, Posttraumatic Stress Disorder symptoms, somatic fear and anxiety, and fear of pain) with opioid use. Results. Every 9-point increase in the Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R) score was associated with 2.37 (95% CI 1.29–4.32) increased odds of preoperative opioid use (p = 0.0005). The SOAPP-R score was also associated with 3.02 (95% CI 1.36–6.70) increased odds of illicit preoperative opioid use (p = 0.007). Also, every 4-point increase in baseline pain at the future surgical site was associated with 2.85 (95% CI 1.12–7.27) increased odds of legitimate preoperative opioid use (p = 0.03). Discussion. Patients presenting with preoperative opioid use have higher SOAPP-R scores potentially indicating an increased risk for opioid misuse after surgery. In addition, legitimate preoperative opioid use is associated with preexisting pain.
Highlights
Previous research has reported prolonged postoperative opioid use in patients already taking opioids prior to surgery [1,2,3]
Elevated SOAPP-R scores in illicit preoperative opioid users are potentially driving the association in the entire opioidusing cohort
As the global Pittsburgh Sleep Quality Index (PSQI) score and Beck Depression InventoryII (BDI-II) score were both significantly associated with any preoperative opioid use in univariate analyses, it is possible that these associations may be just as important as the SOAPP-R in relation to preoperative opioid use
Summary
Previous research has reported prolonged postoperative opioid use in patients already taking opioids prior to surgery [1,2,3]. 30% of women taking preoperative opioids were taking them 6 months after gynecologic surgery compared to 2.2% of women not taking preoperative opioids [2] These findings extend to patients with preoperative chronic opioid use. A higher proportion of chronic opioid users compared to nonusers continued to take opioids 58 months after total hip arthroplasty [5]. Compared to their opioid naıve counterparts, preoperative prescription opioid users have worse functional outcomes [3], worse clinical outcomes [5, 6], increased hospital length of stay [5, 6], increased pain severity after surgery [7] even in the context of increased opioid requirements [8], increased specialist referrals for pain management [6], more dissatisfaction with the surgical outcome [7], and a higher prevalence of postsurgical complications [6]. A history of chronic opioid use in patients with end-stage renal disease was associated with 1.6- to 2-fold increased risk of death after kidney transplantation [9]
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