Preoperative Opioid Utilization Patterns and Postoperative Opioid Utilization: A Retrospective Cohort Study

Area of Science:

• Pain Management
• Surgical Outcomes
• Pharmacology

Background:

• The impact of altering preoperative opioid utilization on postoperative outcomes in chronic users is not well understood.
• Hypothesized that decreasing opioid use would improve outcomes, while increasing use would worsen them.

Purpose of the Study:

• To investigate the association between changes in preoperative opioid utilization and postoperative outcomes among chronic opioid users undergoing surgery.

Main Methods:

• A cohort of 57,019 chronic opioid users (age 18-89) undergoing surgery was identified from insurance claims (2004-2018).
• Patients were categorized by a ≥20% decrease, ≥20% increase, or <20% change (stable) in opioid utilization in the year prior to surgery.
• Primary outcome was postoperative opioid utilization; secondary outcomes included adverse events and healthcare utilization.

Main Results:

• Decreasing preoperative opioid use was associated with a lower likelihood of filling postoperative prescriptions (OR 0.323) but similar daily doses compared to stable users.
• Increasing preoperative opioid use also showed a lower likelihood of filling postoperative prescriptions (OR 0.57) with slightly lower average daily doses.
• No clinically significant differences were observed for most secondary outcomes, including adverse events and healthcare utilization.

Conclusions:

• Preoperative opioid utilization changes (increase or decrease) were not linked to clinically significant differences in key postoperative outcomes, including overall opioid use.
• The study suggests that while preoperative opioid use patterns may influence prescription filling, their impact on broader surgical outcomes is limited in chronic users.