American Society for Enhanced Recovery and Perioperative Quality Initiative-4 Joint Consensus Statement on Persistent...

Area of Science:

• Anesthesiology
• Surgery
• Pain Management
• Public Health

Background:

• Persistent postoperative opioid use is a significant contributor to the ongoing opioid epidemic in the United States.
• Lack of a standardized definition hinders research on incidence and risk factors.

Purpose of the Study:

• To establish a clinically relevant definition for persistent postoperative opioid use.
• To characterize the incidence and risk factors of persistent postoperative opioid use across common surgical procedures.

Main Methods:

• Systematic review of 46 articles identified through literature search.
• Consensus building among international experts from the Perioperative Quality Initiative-4 (anesthesiology, surgery, nursing).
• Focused on adult patients undergoing arthroplasty, abdominopelvic, spine, thoracic, and mastectomy surgeries.

Main Results:

• Overall incidence in opioid-naïve patients is 2-6% (moderate evidence).
• Incidence exceeds 30% in patients with preoperative opioid use.
• Identified risk factors include preoperative opioid use, depression, substance use disorder, preoperative pain, and tobacco use.

Conclusions:

• Preoperative opioid use is a major risk factor for persistent postoperative opioid use.
• Factors like depression, substance use disorder, and tobacco use are associated risks.
• Interventions targeting prescriber behavior and health systems may reduce persistent postoperative opioid use.