Introduction Opioid tapering after surgery is recommended among patients with chronic opioid use, but it is unclear how this process affects their quality of life. The objective of this study was to evaluate how opioid tapering following surgery was associated with patient-reported outcome measures related to pain control and behavioral changes that affect quality of life.
Methods We conducted an explanatory sequential mixed-methods study at a VA Medical Center among patients with chronic opioid use who underwent a spectrum of orthopedic, vascular, thoracic, urology, otolaryngology, and general surgery procedures between 2018 and 2020. Patients were stratified based on the extent that opioid tapering was successful (complete, partial, and no-taper) by 90 days after surgery, followed by qualitative interviews of 10 patients in each taper group. Longitudinal patient-reported outcome measures related to pain intensity, interference, and catastrophizing were compared using Kruskal Wallis tests over the 90-day period after surgery. Qualitative interviews were conducted among patients in each taper group to identify themes associated with the impact of opioid tapering after surgery on quality of life.
Results We identified 211 patients with chronic opioid use (92% male, median age 66 years) who underwent surgery during the time period, including 42 (20%) individuals with complete tapering, 48 (23%) patients with partial tapering, and 121 (57%) patients with no taper of opioids following surgery. Patients who did not taper were more likely to have a history of opioid use disorder (10%—partial, 2%—complete vs 17%—no taper, p<0.05) and be discharged on a higher median morphine equivalent daily dose (52—partial, 30—complete vs 60—no taper; p<0.05) than patients in the partial and complete taper groups. Pain interference (−7.2—partial taper and −9.8—complete taper vs −3.5—no taper) and pain catastrophizing (−21.4—partial taper and −16.5—complete taper vs −1.7—no taper) scores for partial and complete taper groups were significantly improved at 90 days relative to baseline when compared with patients in the no-taper group (p<0.05 for both comparisons), while pain intensity was similar between groups. Finally, patients achieving complete and partial opioid tapering were more likely to report improvements in activity, mood, thinking, and sleep following surgery as compared with patients who failed to taper.
Conclusions Partial and complete opioid tapering within 90 days after surgery among patients with chronic opioid use was associated with improved patient-reported measures of pain control as well as behaviors that impact a patient’s quality of life.
- Acute Pain
- Pain Management
- Opioid-Related Disorders
- Analgesics, Opioid
- Outcome Assessment, Health Care
Data availability statement
Data are available on reasonable request.
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Twitter @BenjaminSBrooke, @DrKimBaylessNP
Contributors All authors (BSB, KB, ZA, TAH, CZ, JH and MJB) made substantial contributions to the study design, data analysis, and data interpretation, actively participated in drafting and critically revising the manuscript, provided final approval of the submitted version, and agree to be held accountable for the accuracy and integrity of the finished publication. BSB is the guarantor who accepts full responsibility for the finished work and the conduct of the study as well as having access to the data and controlled the decision to publish.
Funding This study was funded by Office of Rural Health (14434).
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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