Hilliard PE, et al. - Researchers sought to ascertain the prevalence of preoperative opioid use and the characteristics of these patients in a broadly representative surgical cohort. At a large Midwestern academic medical center, they conducted this cross-sectional study of 34,186 patients undergoing surgery and identified preoperative opioid use among 23.1% patients. Preoperative opioid use was identified to be independently associated with age, tobacco use, illicit drug use, higher pain severity, depression, higher Fibromyalgia Survey scores, lower life satisfaction, and more medical comorbidities. They recommend surgeons to recognize patients using opioids preoperatively and establish a safe and effective acute pain management plans, which may include preoperative reduction of opioid use, naloxone rescue strategies at discharge, and a rational plan of postoperative opioid prescribing.

Methods

• Researchers undertook a cross-sectional, observational study including patients undergoing surgery at a tertiary care academic medical center.
• From March 1, 2010, through April 30, 2016, they collected data as a part of large prospective institutional research registries.
• They assessed preoperative patient and procedural characteristics, including prospectively assessed self-reported pain and functional measures.
• Patient-reported opioid use before surgery was determined as the main outcome measure.

Results

• Researchers recruited 34,186 patients (54.2% women; mean [SD] age, 53.1 [16.1] years); in 7894/34,186 (23.1%) patients, they reported preoperative opioid use.
• Hydrocodone bitartrate (4685 [59.4%]), tramadol hydrochloride (1677 [21.2%]), and oxycodone hydrochloride (1442 [18.3%]) were identified as the most common opioids used.
• Preoperative opioid use was observed in independent association with age of 31 to 40 years (adjusted odds ratio [aOR], 1.26; 95% CI, 1.10-1.45), tobacco use (former use aOR, 1.32 [95% CI, 1.22-1.42]; current use aOR, 1.62 [95% CI, 1.48-1.78]), illicit drug use (aOR, 1.74; 95% CI, 1.16-2.60), higher pain severity (aOR, 1.33; 95% CI, 1.31-1.35), depression (aOR, 1.22; 95% CI, 1.12-1.33), higher Fibromyalgia Survey scores (aOR, 1.06, 95% CI, 1.05-1.07), lower life satisfaction (aOR, 0.95, 95% CI, 0.93-0.96), and more medical comorbidities (American Society of Anesthesiology score aOR, 1.47 [95% CI, 1.37-1.58]; Charlson Comorbidity Index aOR, 1.29 [95% CI, 1.18-1.41]).
• Patients undergoing orthopedic (226 [65.1%]) and neurosurgical spinal (596 [55.1%]) procedures reported preoperative opioid use most commonly; their use was least common among patients undergoing thoracic procedures (244 [15.7%]).
• After adjusting for patient characteristics, patients undergoing lower extremity procedures displayed a higher tendency for preoperative opioid use (aOR, 3.61; 95% CI, 2.81-4.64), as well as those undergoing pelvic (excluding hip) (aOR, 3.09; 95% CI, 1.88-5.08), upper extremity (aOR, 3.07; 95% CI, 2.12-4.45), and spinal or spinal cord (aOR, 2.68; 95% CI, 2.15-3.32) procedures, with the group undergoing intrathoracic surgery as the reference group.