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Are Prescriptions for Preoperative Opioids Common?

July 12, 2018

Nearly 1 in 4 patients scheduled to undergo surgery report preoperative opioid use, according to new research published in JAMA Surgery.

This finding emerged from a study of 34,186 patients undergoing surgery at a tertiary care academic medical center. The study took place from March 1, 2010, to April 30, 2016.

Preoperative patient and procedural characteristics were recorded. Self-reported pain and functional measures were also examined.

Ultimately, results of the study demonstrated that 7894 (23.1%) participants had reported preoperative opioid use. Hydrocodone bitartate (59.4%), tramadol hydrochloride (21.2%), and oxycodone hydrochloride were the most commonly used opioids in this cohort (59.4%, 21.2%, and 18.3%, respectively).

The following factors were all found to be independently associated with preoperative opioid use:

  • Age 31 to 40 years (adjusted odds ratio [aOR], 1.26)
  • Tobacco use:
    • Former use aOR: 1.32
    • Current use aOR: 1.62
  • Illicit drug use (aOR 1.74)
  • Higher pain severity (aOR 1.33)
  • Depression (aOR 1.22)
  • Higher Fibromyalgia Survey scores (aOR 1.06)
  • Lower life satisfaction (aOR 0.95)
  • More medical comorbidities:
    • American Society of Anesthesiology score aOR: 1.47
    • Charlson Comorbidity Index aOR: 1.29

Rates of opioid use were highest among patients undergoing orthopedic and neurosurgical spinal procedures (65.1% and 55.1%, respectively), and lowest among patients undergoing thoracic procedures (15.7%)

Following adjustment, odds of reporting preoperative opioid use were highest among patients undergoing lower extremity procedures (aOR 3.61), along with patients undergoing pelvic (excluding hip; aOR 3.09), upper extremity (aOR 3.07), and spinal or spinal cord procedures (aOR 2.68) compared with those undergoing intrathoracic surgery.

“These data provide important insights into this complicated patient population that would appear to help guide future preoperative optimization and perioperative opioid-weaning interventions,” the researchers wrote.

—Christina Vogt

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