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Original Investigation
October 2018

Prevalence of Preoperative Opioid Use and Characteristics Associated With Opioid Use Among Patients Presenting for Surgery

Author Affiliations
  • 1Division of Pain Medicine, Department of Anesthesiology, University of Michigan Health System, Ann Arbor
  • 2Department of Surgery, University of Michigan Health System, Ann Arbor
  • 3Institute of Healthcare Policy and Innovation, University of Michigan, Ann Arbor
  • 4currently a medical student at University of Michigan Health System Medical School, Ann Arbor
  • 5Chronic Pain and Fatigue Research Center, Department of Anesthesiology, Domino’s Farms, Ann Arbor, Michigan
  • 6Division of Rheumatology, Department of Internal Medicine, University of Michigan Health System, Ann Arbor
  • 7School of Public Health, University of Michigan Health System, Ann Arbor
JAMA Surg. 2018;153(10):929-937. doi:10.1001/jamasurg.2018.2102
Key Points

Question  What are the prevalence of preoperative opioid use and the characteristics of these patients in a representative surgical cohort?

Findings  In this cross-sectional study of 34 186 patients undergoing surgery at a large Midwestern academic medical center, 23.1% reported preoperative opioid use. Age, tobacco use, illicit drug use, higher pain severity, depression, higher Fibromyalgia Survey scores, lower life satisfaction, and more medical comorbidities were independently associated with preoperative opioid use.

Meaning  Surgeons need to identify patients using opioids preoperatively and establish a safe and effective acute pain management plan, which may include preoperative reduction of opioid use, naloxone rescue strategies at discharge, and a rational plan of postoperative opioid prescribing.

Abstract

Importance  Patterns of preoperative opioid use are not well characterized across different surgical services, and studies in this patient population have lacked important self-reported data of pain and affect.

Objectives  To assess the prevalence of preoperative opioid use and the characteristics of these patients in a broadly representative surgical cohort.

Design, Setting, and Participants  Cross-sectional, observational study of patients undergoing surgery at a tertiary care academic medical center. Data were collected as a part of large prospective institutional research registries from March 1, 2010, through April 30, 2016.

Exposures  Preoperative patient and procedural characteristics, including prospectively assessed self-reported pain and functional measures.

Main Outcomes and Measures  Patient-reported opioid use before surgery.

Results  Of the total 34 186 patients recruited (54.2% women; mean [SD] age, 53.1 [16.1] years), preoperative opioid use was reported in 7894 (23.1%). The most common opioids used were hydrocodone bitartrate (4685 [59.4%]), tramadol hydrochloride (1677 [21.2%]), and oxycodone hydrochloride (1442 [18.3%]). 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]) were all independently associated with preoperative opioid use. Preoperative opioid use was most commonly reported by patients undergoing orthopedic (226 [65.1%]) and neurosurgical spinal (596 [55.1%]) procedures and least common among patients undergoing thoracic procedures (244 [15.7%]). After adjusting for patient characteristics, the patients undergoing lower extremity procedures were most likely to report 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.

Conclusions and Relevance  In this large study of preoperative opioid use that includes patient-reported outcome measures, more than 1 in 4 patients presenting for surgery reported opioid use. These data provide important insights into this complicated patient population that would appear to help guide future preoperative optimization and perioperative opioid-weaning interventions.

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