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Trajectories of opioid consumption from day of surgery to 28 days postoperatively: a prospective cohort study in patients undergoing abdominal, joint, or spine surgery
  1. Robert J McCarthy,
  2. Ashley Meng Adams,
  3. Amanda C Sremac,
  4. Wendy Jo Kreider,
  5. Pete L Pelletier and
  6. Asokumar Buvanendran
  1. Anesthesiology, Rush University, Chicago, Illinois, USA
  1. Correspondence to Dr Robert J McCarthy, Anesthesiology, Rush University, Chicago, Illinois, USA; Robert_J_McCarthy{at}rush.edu

Abstract

Introduction Descriptions of opioid use trajectories and their association with postsurgical pain and opioid consumption are limited. We hypothesized that trajectories of opioid consumption in the first 28 days following surgery would be associated with unique patterns of pain and duration of opioid use.

Methods A prospective longitudinal cohort of patients undergoing elective inpatient abdominal, joint, or spine surgery between June 2016 and June 2019 was studied. At hospital discharge and every 7 days for 28 days, patients were assessed for pain, analgesic use, pain interference, satisfaction, and side effects. Duration of opioid use was determined for 6 months. The primary analysis used latent class group modeling to identify trajectories of opioid use.

Results Decreasing, high, and persistent opioid trajectories were identified following joint and spine surgery and a decreasing and persistent trajectory following abdominal surgery. Reported pain was greater in the high and persistent trajectories compared with the decreasing use trajectories. Compared with the decreasing opioid trajectory, the median duration of opioid use was increased by 4.5 (95% CI 1 to 22, p<0.01) weeks in persistent opioid use abdominal and by 6 (95% CI 0 to 6, p<0.01) weeks in the high or persistent use joint and spine groups. The odds (95% CI) of opioid use at 6 months in the high or persistent opioid use trajectory was 24.3 (2.9 to 203.4) for abdominal and 3.7 (1.9 to 7.0) for joint or spine surgery compared with the decreasing use trajectory. Morphine milliequivalent per 24 hours of hospitalization was the primary independent predictor of opioid use trajectories.

Conclusions We observed distinct opioid use trajectories following abdominal and joint or spine surgery that were associated with different patterns of pain and duration of opioid use postoperatively. Prediction of postoperative opioid use trajectory groups may be clinically important for identifying risk of prolonged opioid use.

  • postoperative pain
  • pain
  • postoperative
  • outcomes
  • analgesia
  • analgesics
  • opioid

Data availability statement

Data are available on reasonable request. Deidentified participant may be available from RJM (ORIC id:0000-0002-0966-5311), the corresponding author, on request and execution of a data use agreement.

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Data availability statement

Data are available on reasonable request. Deidentified participant may be available from RJM (ORIC id:0000-0002-0966-5311), the corresponding author, on request and execution of a data use agreement.

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Footnotes

  • Twitter @PetePelletierMD

  • Contributors RJM was involved in the oversight of the study, acquisition and analysis of the data, drafting the article, critical revision of the article, and final approval of the version to be published. AMA was involved in the acquisition of the data, drafting the article, critical revision of the article, and final approval of the version to be published. ACS was involved in the acquisition of the data, drafting the article, critical revision of the article, and final approval of the version to be published. WJK was involved in the acquisition of the data, drafting the article, critical revision of the article, and final approval of the version to be published. PLP was involved in the conception or design of the study, drafting the article, critical revision of the article, and final approval of the version to be published. AB was involved in the conception or design of the study, drafting the article, critical revision of the article, and final approval of the version to be published.

  • Funding This study was supported by Department of Anesthesiology internal funding.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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